In medical settings, the acronym DNI stands for “Do Not Intubate.” This is a specific medical order directing healthcare providers to withhold the life-sustaining procedure of mechanical support during severe respiratory distress. The decision is typically part of a patient’s advance care planning. A DNI order is often made in the context of terminal or advanced chronic illness when the potential burdens of intubation are judged to outweigh the benefits.
What “Do Not Intubate” Specifically Means
The “Do Not Intubate” order specifically prohibits endotracheal intubation. Intubation involves inserting a flexible plastic tube, known as an endotracheal tube, through the mouth or nose into the windpipe (trachea) to secure an open airway. This tube is then connected to a mechanical ventilator, which takes over the work of breathing by pushing oxygen-rich air into the lungs.
A DNI order is invoked when a patient experiences respiratory failure and cannot breathe adequately on their own. For patients with advanced disease, mechanical ventilation may only prolong suffering without offering a meaningful chance of recovery. The procedure carries risks, including injury to the throat, vocal cords, or teeth. By choosing DNI, a patient elects to avoid this invasive intervention, even if it becomes necessary to sustain life.
DNI Compared to DNR
The distinction between a DNI order and a Do Not Resuscitate (DNR) order is important, as they cover different scopes of intervention. A DNR order is the broader directive, meaning no attempts at cardiopulmonary resuscitation (CPR) will be made if the patient experiences cardiac or respiratory arrest. CPR is a multi-step intervention that includes chest compressions, electrical shocks, and cardiac drugs, with intubation being part of the full resuscitation protocol.
A DNI order, conversely, is narrowly focused, prohibiting only the placement of the breathing tube and connection to a ventilator. Patients with a DNI order, but not a DNR order, may still receive other resuscitative measures, such as chest compressions and cardiac medications, if their heart stops. This allows a patient to decline the specific burdens of mechanical ventilation while still consenting to other life-saving measures. A full DNR order inherently includes the DNI component, as intubation is a part of the complete resuscitation protocol.
Treatments Permitted Under a DNI Order
A common misconception is that a DNI order means all medical care is withheld, but this is inaccurate. The DNI order is highly specific and only prevents the invasive insertion of the endotracheal tube. Patients with a DNI order still receive the full range of medical treatments aimed at comfort, symptom management, and addressing reversible conditions.
Permitted treatments include supplemental oxygen delivered via a nasal cannula or face mask. Non-invasive ventilation methods like BiPAP or CPAP, which use a mask to push air into the lungs, are also permitted. Furthermore, a patient continues to receive necessary medications, such as antibiotics, IV fluids for hydration, and pain medications for comfort. The focus of care shifts from aggressive life prolongation to maximizing the patient’s quality of life and comfort.
The Process of Documenting a DNI Order
The decision to establish a DNI order is a formal process requiring clear communication and documentation within the patient’s medical record. This begins with a detailed discussion between the patient, or their legally appointed surrogate decision-maker, and the attending physician. The physician must ensure the patient understands the nature of intubation, the risks, the potential outcomes, and the specific limitations the order imposes on future care.
Once the patient or surrogate provides informed consent, the physician writes the DNI order in the medical chart. This order is a legally binding instruction for the entire healthcare team and is often part of a broader Advance Directive, such as a Living Will. The documentation must be explicit, signed by the physician, and easily accessible to all providers to prevent misunderstanding in an emergency.