This pamphlet provides an overview on Do Not Resuscitate (DNI) orders. A comparison of DNI and DNR orders is included.
Missouri USLegal Pamphlet on Do Not Intubate - DNI
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US-PMPH-05
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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.
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.
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.
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.
DNR means that no CPR (chest compressions, cardiac drugs, or placement of a breathing tube) will be performed. A DNI or Do Not Intubate order means that chest compressions and cardiac drugs may be used, but no breathing tube will be placed.
A patient has the option to be Full Code, DNR (Do Not Resuscitate), DNI (Do Not Intubate) or both DNR and DNI.
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.
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.
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.
Full Code: defined as full support which includes cardiopulmonary resuscitation (CPR), if the patient has no heartbeat and is not breathing. DNR: The patient does not want CPR the person has no heart beat and is not breathing, but may want other life-sustaining treatments.
