donotintubate

Do-not-intubate (DNI) is a medical directive or order that indicates a patient should not be intubated with an endotracheal tube or subjected to initiation of mechanical ventilation. It is distinct from a do-not-resuscitate (DNR) order, which addresses whether to perform CPR in the event of cardiac arrest; a DNI only restricts airway management and ventilation and may be part of a broader code status that includes or excludes other interventions.

Usage: DNI is typically requested by the patient, a surrogate, or a clinician in settings such as acute illness, advanced frailty, dementia, or terminal illness where the burdens of intubation and ventilation are deemed to outweigh benefits. It applies to the hospital or care setting where the order is documented and validated. It does not necessarily preclude all treatments; noninvasive oxygen therapy and palliative measures may still be used unless specified.

Documentation and communication: The DNI order should be documented in the patient's medical record, often after explicit discussion, and may be part of an advance directive or treatment escalation plan. The patient or authorized surrogate can revoke or modify the order at any time if capacity allows.

Legal and ethical considerations: DNI policies vary by jurisdiction and institution. It involves patient autonomy, beneficence, non-maleficence, and shared decision-making, and may be influenced by cultural and spiritual beliefs. In emergencies, clinicians may be obligated to provide temporary life-sustaining interventions until a DNI order is clarified.

Impact and limitations: A DNI does not guarantee comfort or survival; outcomes depend on underlying condition, comorbidities, and the overall care plan. It should be reviewed regularly and integrated with goals of care, palliative care involvement, and clear communication with family.