Consequences in critically ill patients with prolonged mechanical ventilation after diaphragmatic stimulation techniques: a systematic review and meta-analysis.

Abstract

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. Systematic review and meta-analysis. Cochrane library, Embase, Pubmed and Web of Science up to December 2024. Randomised controlled trials (RCTs) and cohort studies evaluating the outcomes of patients with prolonged MV after diaphragmatic stimulation were included up to December 2024. 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). 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. The promising results suggest that diaphragmatic stimulation has the potential to shorten DMV and ILOS and accelerate weaning from ventilator. CRD42024599512.