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Consequences in critically ill patients with prolonged mechanical ventilation after diaphragmatic stimulation

Siqi Tong¹, Yi Yang², Yang Li¹

¹Southeast University, Nanjing, China.

|September 23, 2025

Abstract

Objective:

Prolonged mechanical ventilation (MV) may lead to poor outcomes. This systematic review and meta-analysis aimed to investigate the effects of diaphragmatic stimulation on the duration of MV (DMV), the intensive care unit (ICU) length of stay (ILOS), the proportion of patients successfully weaned and maximum inspiratory pressure (MIP) in patients with prolonged MV.

Design:

Systematic review and meta-analysis.

Data Sources:

Cochrane library, Embase, Pubmed and Web of Science up to December 2024.

Eligibility Criteria For Selecting Studies:

Randomised controlled trials (RCTs) and cohort studies evaluating the outcomes of patients with prolonged MV after diaphragmatic stimulation were included up to December 2024.

Data Extraction And Synthesis:

All articles were independently assessed by two reviewers, and a third reviewer was consulted to resolve different evaluations. Newcastle-Ottawa Scale (NOS) and the Cochrane Collaboration tool in RevMan V.5.3 software (The Cochrane Collaboration, 2014) were applied to assess the quality of cohort studies or RCTs. The meta-analysis was carried out with RevMan V.5.3 software, applying a random-effects model and presenting results with 95% CIs. Heterogeneity was examined using the Higgins I² statistic, and subgroup analyses were carried out to investigate possible contributors to heterogeneity. Sensitivity analyses were further conducted in Stata 18.0 (StataCorp LP, College Station, TX, USA). Potential publication bias was assessed through funnel plots combined with Egger's regression test. For each outcome, the certainty of evidence was appraised according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results:

Ten studies involving 802 patients (349 received diaphragmatic stimulation) were included. The meta-analysis indicated that patients receiving diaphragmatic stimulation had shorter DMV (mean differences (MD) -5.69 d, 95% CI -10.99 to -0.39, p=0.04) and ILOS (MD -5.48 d, 95% CI -10.72 to -0.24, p=0.04). The proportion of patients successfully weaned was larger in patients with diaphragmatic stimulation (risk ratios (RR) 1.25, 95% CI 1.01 to 1.53, p=0.04). The MIP increased compared with the control group.

Conclusions:

The promising results suggest that diaphragmatic stimulation has the potential to shorten DMV and ILOS and accelerate weaning from ventilator.

Prospero Registration Number:

CRD42024599512.

Insights

Diaphragmatic stimulation may shorten the duration of mechanical ventilation (MV) and intensive care unit (ICU) length of stay. This intervention also increases the success rate of weaning patients from ventilators.

Area of Science:

Critical Care Medicine
Pulmonology
Respiratory Therapy

Background:

Prolonged mechanical ventilation (MV) is associated with adverse patient outcomes.
Effective strategies to reduce MV duration and improve weaning are crucial in intensive care settings.

Purpose of the Study:

To systematically review and meta-analyze the impact of diaphragmatic stimulation on key outcomes in patients requiring prolonged MV.
To evaluate effects on duration of MV (DMV), ICU length of stay (ILOS), successful weaning rates, and maximum inspiratory pressure (MIP).

Main Methods:

Systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies.
Searched Cochrane library, Embase, PubMed, and Web of Science up to December 2024.
Assessed study quality using Newcastle-Ottawa Scale and Cochrane Collaboration tool; meta-analysis performed using RevMan V.5.3 with random-effects model.

Main Results:

Ten studies with 802 patients (349 received diaphragmatic stimulation) were included.
Diaphragmatic stimulation significantly reduced DMV (MD -5.69 d) and ILOS (MD -5.48 d).
Successful weaning proportion increased (RR 1.25), and MIP improved compared to controls.

Conclusions:

Diaphragmatic stimulation shows promise in reducing DMV and ILOS.
This intervention may accelerate ventilator weaning and improve respiratory muscle strength.
Further research supports diaphragmatic stimulation as a beneficial strategy for prolonged MV patients.

Read full analysis

Keywords:

Electric Stimulation Therapy Respiratory Therapy Ventilators, Mechanical

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