“Do not intubate” (DNI) and “do not resuscitate” (DNR) are two different entities. Often times a tenuous cardiopulmonary status or altered mentation requires securing the airway with endotracheal intubation well before full-on resuscitation with advanced cardiopulmonary life support (ACLS).
However, once we get to the point of cardiopulmonary arrest and resuscitative efforts are underway, it’s my opinion that securing the airway should be implied. In other words, if you are okay with us initiating chest compressions, we should also be allowed to intubate your trachea.
Discussing goals of care is of paramount importance in the perioperative and critical care settings, so I try to make it a point for my patients and their families to understand what ACLS actually entails. It’s not like daytime television. ACLS is violent, and usually not successful with full cardiac arrest. By leaving the airway vulnerable, we risk things which would only complicate resuscitative efforts like pulmonary aspiration or hypoventilation.
Do you give your patients the option for DNI without DNR? Does DNI also mean DNR? Drop me a comment with your thoughts.