Yet another ethical question...

KelRN215, BSN, RN · Nov 11, 2018

Well DNI means "do not intubate" it doesn't mean "do not use other means of respiratory support."

I am not familiar with this product so I Googled it and the brochure says "The Philips Respironics V60 ventilator is a microprocessor-

controlled, bi-level positive airway pressure ventilatory assist system that provides noninvasive and invasive ventilatory support for adult and pediatric patients (> 20 kg)."

So it's BiPAP? DNI doesn't mean no BiPAP. The Attending MD should discuss wishes about use of BiPAP or CPAP with the patient/patient's family when discussing end of life wishes. I had many patients when I worked in the hospital who were DNIs but on BiPAP (both chronically and acutely).

Guest219794 · Nov 12, 2018

I would say that, from an ethical standpoint, the most important factor would be the PTs wishes.

Whether something meets a technical definition is secondary.

Clearly if this machine does not involve intubating, using it does not violate the order. But, does it violate the PTs wishes?

Using a mechanical ventilator and an LMA on a PT with a DNI would not violate the order, but would almost certainly violate the PTs wishes.

**CalicoKitty, BSN, MSN, RN** · Nov 12, 2018

It may also depend on the comfort level. Being intubated is very invasive. People may feel like they are being choked. Their throat may hurt. It can be very scary. If this system doesn't cause the same level of pain, anxiety or discomfort, it really wouldn't be the same as intubation. Other considerations are if this is long-term vs short-term.

ventmommy · Nov 12, 2018

The V60 isn't necessarily the most comfortable thing in the world but it's very effective at oxygenation and ventilation. So if the patient is disoriented because of hypercapnia or hypoxia, it would be a good way to get them normalized to discuss their short- and long-term plans.