Effect of Diaphragmatic Neuromuscular Electrical Stimulation on Diaphragm Function and Clinical Outcomes in ICU Mechanically Ventilated Patients: A Meta-analysis and Systematic Review
In brief
Electrical diaphragm stimulation shortened ventilation by about 2 days in pooled trials
Across 19 randomized trials involving 1,437 ICU patients, stimulation improved measures of diaphragm function and was linked to about 2 fewer days on a ventilator and a 29% higher weaning success rate. ICU stays were also shorter, but confidence in many outcomes is low or very low because of study limitations and variation; larger, better-reported trials are needed.
- Journal
- American journal of physical medicine & rehabilitation (Q1)
- Published
- 3 November 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yayu Ren, Junqing Chu, Wenbo Qiao, Feifei Zhou, Ke Geng, Ming Sang, et al.
- PMID
- 42973384
- DOI
- 10.1097/PHM.0000000000003191
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 5 November 2026): Systematic review of diaphragm stimulation and ventilator weaning
Abstract
OBJECTIVE: To evaluate the effects of diaphragmatic neuromuscular electrical stimulation (DNMES) on diaphragmatic function and clinical outcomes in mechanically ventilated patients in the intensive care unit (ICU). METHODS: We searched major databases to May 2026 for RCTs. Two reviewers independently screened studies, extracted data, assessed bias, and performed meta-analysis; GRADE assessed evidence certainty. RESULTS: Nineteen RCTs (1,437 patients) were included. Meta-analysis showed that DNMES significantly improved diaphragmatic thickening fraction (DTF) (SMD=1.32, 95%CI[0.73, 1.91], P<0.0001), diaphragmatic excursion (DE) (SMD=1.25, 95%CI[0.77, 1.72], P<0.00001), maximal inspiratory pressure (MIP) (MD=2.46, 95%CI[1.22, 3.69], P<0.0001), and rapid shallow breathing index (RSBI) (MD=-14.08, 95%CI[-21.38, -6.77], P=0.0002). DNMES also reduced the duration of mechanical ventilation (MD=-2.14, 95%CI[-2.84, -1.43], P<0.00001) and ICU length of stay (MD=-2.30, 95%CI[-2.85, -1.75], P<0.00001), increased weaning success rate (RR=1.29, 95%CI[1.17, 1.42], P<0.00001), and decreased weaning failure rate (RR=0.62, 95%CI[0.49, 0.77], P<0.0001). GRADE evidence quality assessment revealed moderate quality for 2 outcomes, low quality for 3 outcomes, and very low quality for 3 outcomes. CONCLUSION: DNMES may improve diaphragmatic function and weaning outcomes, shorten ventilation and ICU stay, but the certainty of evidence remains predominantly low to very low due to substantial heterogeneity, high risk of bias, and limited trial reporting; large RCTs are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.