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Do Not Endotracheal Intubate Order, Use of Noninvasive Ventilation

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Noninvasive Mechanical Ventilation

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Abstract

Physicians can place a Do Not Intubate (DNI) order and thus withhold invasive mechanical ventilation, one of the supportive treatments for acute respiratory failure while treating the underlying etiology. A DNI order can be based on the clinician’s decision that this invasive procedure would not offer any therapeutic benefit, taking into account the patient’s diagnosis, prognosis, and goals of the medical treatment change; due to the patient’s preference for no intubation and invasive ventilation; the triage decisions in hospitals with a lack of resources, with limited Intensive Care Unit beds and ventilators. DNI variability exists across continents; there are important differences between countries and hospitals within a country, and this may reflect differences in policies, practices, medical ethics, social attitudes, culture, and religion regarding providing treatments that are non-beneficial.

There has been an increasing rate of DNI orders over the past two decades, reflecting an increased focus on high quality end-of-life care, the changing ethical climates, cost-consciousness in decision making, and the increasing use of other supportive treatments such as high-flow nasal cannula oxygen and noninvasive ventilation.

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  1. Intensive Care Unit, Hospital Instituto Português de Oncologia, Porto, Portugal

    Brigitte Mathias Leal Dias Pereira

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  1. Brigitte Mathias Leal Dias Pereira
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  1. Murcia, Spain

    Antonio M. Esquinas

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Pereira, B.M.L.D. (2023). Do Not Endotracheal Intubate Order, Use of Noninvasive Ventilation. In: Esquinas, A.M. (eds) Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-031-28963-7_72

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