This pamphlet provides an overview on Do Not Resuscitate (DNI) orders. A comparison of DNI and DNR orders is included.
Iowa USLegal Pamphlet on Do Not Intubate - DNI
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US-PMPH-05
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FAQ
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 DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided.
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.
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.
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.
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.
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.
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.
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.
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.
More info
Advance directive is a general term for your verbal and written wishes about your medical care in the future. These are only used if you are not able to ...