This pamphlet provides an overview on Do Not Resuscitate (DNI) orders. A comparison of DNI and DNR orders is included.
Maryland USLegal Pamphlet on Do Not Intubate - DNI
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US-PMPH-05
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FAQ
A natural reaction to medicine's use of CPR and MV was the advent of advance directives and more specific Do-Not-Resuscitate (DNR) and Do-Not-Intubate (DNI) orders meant to protect a patient's ability to remain autonomous with their end of life decisions. 1.
DNI's only apply to situations where a patient has no pulse or is not breathing, but they do not restrict any other clinically indicated care. There does not need to be a formal advance directive or living will to have DNR and DNI orders in place.
It is an emergency rescue technique that was developed to save the life of people who are generally in good health. NOTE: If you do not have a DNR orders, health care providers will begin CPR in an emergency.
Strictly defined, a do not resuscitate/do not intubate (DNR/DNI) status indicates a patient does not want to receive CPR or intubation in the event of cardiopulmonary arrest.
A DNI or Do Not Intubate order means that chest compressions and cardiac drugs may be used, but no breathing tube will be placed. An AND or Allow Natural Death order is a term used at some hospitals as an alternative to the more traditional DNR order.
A ventilator keeps oxygen flowing into and out of the lungs when patients are unable to breathe on their own. A patient can sign a DNI and continue to benefit from oxygen therapy and non-invasive ventilation, such as through BiPAP.
Choosing a Do Not Intubate Order DNI's only apply to situations where a patient has no pulse or is not breathing, but they do not restrict any other clinically indicated care. There does not need to be a formal advance directive or living will to have DNR and DNI orders in place.
In medical terms, a DNI means that patients do not want a breathing tube inserted into their trachea, via the nose or mouth, to restore normal breathing. If the patient's breathing remains impaired, the tube remains in place and is eventually connected to a ventilator to maintain breathing.
Conclusions: Conflation of DNR and DNI into DNR/DNI does not reliably distinguish patients who refuse or accept intubation for indications other than cardiac arrest, and thus may inappropriately deny desired intubation for those who would accept it, and inappropriately impose intubation on patients who would not.
When you request a Do Not Resuscitate (DNR) order, your doctor may ask you whether or not you also want a Do Not Intubate (DNI) order. The two are separate because you can have trouble breathing before your heartbeat or breathing stops. If your breathing problems continue, your heart or lungs may go into full arrest.
