Do Not Intubate Orders Without Do Not Resuscitate Orders

Introduction to DNI and DNR Distinction

A patient can have a Do Not Intubate (DNI) order without a Do Not Resuscitate (DNR) order, as these are separate medical decisions that must be documented independently and explicitly, according to Praxis Medical Insights 1
DNR specifically prohibits chest compressions and defibrillation if cardiac arrest occurs, while DNI specifically prohibits endotracheal intubation, which applies to multiple situations beyond cardiac arrest, including respiratory failure, airway protection, and surgical procedures 1

When a patient has DNI but no DNR order, full resuscitative efforts including chest compressions and defibrillation should be provided if cardiac arrest occurs, as recommended by Praxis Medical Insights 1
All appropriate medical interventions, such as vasopressors, oxygen support, electrolyte replacement, IV fluids, pain management, and antibiotics, should be provided to patients with DNI orders without DNR, according to Praxis Medical Insights 1
Non-invasive respiratory support, such as BiPAP or high-flow nasal cannula, can be used for respiratory distress in patients with DNI orders without DNR, as stated by Praxis Medical Insights 1
Endotracheal intubation should be withheld for any indication, including respiratory failure, airway protection, and surgical procedures, in patients with DNI orders without DNR, as recommended by Praxis Medical Insights 1

Explicit separate orders for each limitation must be written when implementing DNI orders without DNR, and oral orders are never acceptable, according to Praxis Medical Insights 1
Essential documentation must include a clear statement of the patient's capacity at the time of decision-making, the date of DNI order implementation, and specific interventions to be withheld, as stated by Praxis Medical Insights 1
DNI orders without DNR should be reviewed periodically, particularly if the patient's condition changes, and before surgery, to determine applicability in the operating suite, as recommended by Praxis Medical Insights 1

Aggressive full care should be provided early after ICU admission, and new DNR orders should be postponed until at least the second full day of hospitalization for most critically ill patients, according to Stroke 2 and Praxis Medical Insights 3
DNI status does not limit the use of vasopressors, oxygen support, electrolyte replacement, IV fluids, pain management, or antibiotics, as stated by Praxis Medical Insights 1 and 3
DNI status can be suspended for procedures when appropriate after discussion with the patient, as recommended by Praxis Medical Insights 1 and 3