Do Not Intubate in Hospice Care
Do Not Intubate: Respecting Choice, Comfort, and Dignity
Do not intubate (DNI) is a medical order that tells clinicians not to place a breathing tube or use a ventilator if breathing fails. Families often face this decision during serious illness; we help you understand options in Sugar Land, Houston, and nearby areas—and can start care in 24–48 hours.
Definition: A “do not intubate” order instructs healthcare teams to avoid placing a breathing tube and mechanical ventilation during respiratory failure. It may be used with or without a DNR (Do Not Resuscitate) order and is guided by goals, prognosis, and comfort preferences.
What is “do not intubate”?
A DNI order focuses on avoiding invasive airway procedures (endotracheal tube or tracheostomy). Instead, teams may use oxygen, medications, non-invasive ventilation (e.g., BiPAP), and comfort-focused care. Importantly, DNI can still include treatment for reversible problems—pneumonia, fluid overload, or anxiety—aligned with the person’s goals.
Condition-specific context
After stroke: When neurologic injury limits recovery, intubation may not improve quality of life. Therefore, families sometimes choose DNI to prioritize comfort and reduce ICU time.
Advanced COPD or heart failure: Repeated hospitalizations and frailty can make ventilators burdensome. In these cases, a DNI plan can emphasize breath-ease medications, diuretics, and gentle non-invasive support at home.
After major surgery or cancer progression: If recovery prospects are poor, avoiding intubation may prevent prolonged ICU care and tube dependence, while increasing time at home with symptom relief.
What does “do not intubate” mean in practice?
Clinicians will not place a breathing tube when breathing fails. However, they still relieve distress: oxygen, opioids for air hunger, anti-anxiety support, non-invasive ventilation if desired, and careful management of fluids and infections. As a result, patients often experience calmer, more personal care.
Does intubation mean end of life?
No. Many people are intubated temporarily and recover. Yet for serious, progressive illness, intubation can lead to prolonged sedation, delirium, or long ICU stays. Consequently, some patients choose DNI to avoid those burdens and preserve time at home.
What hospice nurses won’t tell you? (They will—clearly.)
Good hospice teams discuss benefits and limits openly. We explain what intubation involves, what DNI changes (and what it doesn’t), and how symptoms are relieved without invasive tubes. Transparency builds trust; there are no hidden rules. For a deeper dive into myths and realities, read what hospice does not tell you and how we address those concerns head-on.
When would you not intubate a patient?
People often choose DNI when:
- Illness is advanced and intubation is unlikely to restore meaningful function.
- Quality-of-life goals prioritize comfort, home time, and interaction over ICU care.
- Prior intubations caused distress, delirium, or prolonged recovery.
- Advance directives specify avoiding invasive life support.
What does DNR mean and how is it different?
A Do Not Resuscitate (DNR) order tells teams not to perform CPR or defibrillation if the heart stops. A DNI limits breathing tubes. Some people choose both (DNR/DNI); others choose DNR with possible non-invasive breathing support. Your plan should match your values.
Talking with family and your care team
Bring questions and your goals. Ask: “What are the likely outcomes with and without intubation for my condition?” and “How can we best manage breathlessness at home?” Then document the decision (physician order, POLST/MOST when applicable) and share copies with family and first responders.
Care can happen where you feel safest and most supported. See where hospice care is provided—from private homes to assisted living and nursing facilities across Sugar Land and Houston. Meet your interdisciplinary hospice care team and how each role supports comfort when following a do not intubate plan.
Further reading: The National Institute on Aging offers a clear overview of advance directives, DNR, and treatment choices—helpful when planning a do not intubate approach. Read the NIA guide.
Mini case studies (realistic scenarios)
Before: Mr. A., 84, advanced COPD, three ICU stays in 6 months. Each time he left weaker and more anxious. After (4 weeks): With a documented DNI and hospice at home, he used low-flow oxygen, fan therapy, and as-needed medications. Breathlessness eased, sleep improved, and hospital trips dropped to zero.
Before: Ms. R., 72, metastatic cancer with recurrent pneumonia. Family worried CPR and intubation would prolong suffering. After (2 weeks): DNR/DNI documented; non-invasive ventilation offered only if comfortable. Focus shifted to time with grandchildren. Symptoms stabilized, and she remained at home.
FAQ
Is “do not intubate” the same as “do not treat”?
No. DNI limits invasive ventilation. You can still receive antibiotics, oxygen, non-invasive ventilation, and full comfort-care measures.
Can I choose DNR but not DNI?
Yes. Some people decline CPR but allow short-term breathing support. Decide with your clinician based on goals and likely outcomes.
Can a DNI be temporary?
Yes. You may revise orders as health changes—after surgery, during rehab, or if prognosis improves.
Will hospice abandon me if I worsen suddenly?
No. Hospice intensifies symptom relief and provides 24/7 support; it simply avoids interventions you’ve declined.
How do first responders know my wishes?
Use state-recognized forms (e.g., POLST/MOST) in a visible place; give copies to family and your hospice team.
Who can sign a DNI?
Typically, the patient or a legally authorized decision-maker; a clinician must write the order according to state rules.
Does insurance cover hospice if I choose DNI?
Yes. Coverage is based on eligibility, not on whether you accept or decline intubation.
Ready to talk through a Do Not Intubate plan?
Call now: 281-245-9977 • Visit: 140 Eldridge Rd, Suite B1, Sugar Land, TX 77478 • Request a call-back. We serve Sugar Land, Houston, and surrounding areas. Services may start within 24–48 hours.
Prefer to read first? Download our “Breathlessness & Comfort Care” guide (PDF) from the contact page.
Disclaimer: Educational content only; follow your clinician’s individualized plan; call 911 for emergencies.
