Diaphragmatic pacing for spinal cord injury patients: impact on weaning rate - a systematic review and meta-analysis

Spinal cord injury (SCI), particularly when affecting the high cervical region, frequently results in diaphragmatic paralysis and subsequent reliance on mechanical ventilation. Although life-sustaining, mechanical ventilation presents its own set of limitations and potential complications. A thorough, quantitative evaluation of diaphragmatic pacing (DP) as an alternative intervention, specifically regarding its influence on weaning success rates in SCI patients, has been notably absent. This investigation aimed to address these existing knowledge gaps.

Two independent researchers conducted a systematic search across PubMed, Embase, the Cochrane Library, and Web of Science databases, encompassing all publications from their inception until March 17, 2025. Eligibility criteria prioritized within-cohort comparative studies involving SCI patients undergoing DP, which reported weaning rate. The risk of bias was evaluated using the ROBINS-I tool. A meta-analysis was subsequently performed utilizing Cochrane Review Manager 5.4, employing a random-effects model to account for clinical and methodological heterogeneity.

The meta-analysis ultimately incorporated 6 articles. All six studies reported weaning rate after diaphragmatic pacing. The pooled weaning success rate was 75% (95% CI: 69%-81%) with no statistical heterogeneity ([Formula: see text], [Formula: see text]).

Diaphragmatic pacing appears to be associated with a substantial weaning success rate among individuals with spinal cord injury. Nevertheless, these findings warrant cautious interpretation due to the prevalence of non-randomized study designs, restricted sample sizes, and inherent clinical heterogeneity across the included literature, resulting in a Very Low certainty of evidence as per GRADE assessment. Consequently, further high-quality, large-scale randomized controlled trials are imperative to substantiate these conclusions.