Clinical outcomes of diaphragm pacing in facilitating weaning from mechanical ventilation: a systematic review and meta-analysis.

BACKGROUND

While early rehabilitation is widely implemented in intensive care units (ICUs) for patients requiring mechanical ventilation (MV), the clinical effectiveness of external diaphragm pacing (EDP) in this context remains unclear. This systematic review and meta-analysis aimed to evaluate the impact of EDP on clinical outcomes in patients receiving MV and to provide evidence to inform future research.

METHODS

A comprehensive search of nine electronic databases was conducted from inception to January 2026, for randomized controlled trials (RCTs) comparing EDP with control in MV patients. Data were analyzed using Review Manager version 5.4. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool (RoB 2.0). The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. This study followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

RESULTS

Fourteen RCTs involving 862 patients (430 in EDP group, 432 controls) were included. Meta-analysis revealed that EDP significantly reduced the duration of MV [mean difference (MD) =-1.51 days, 95% confidence interval (CI): -2.41 to -0.61, P=0.02], increased the rate of successful weaning [odds ratio (OR) =3.45, 95% CI: 2.14-5.56, P<0.001], and shortened ICU length of stay (MD =-2.88 days, 95% CI: -3.37 to -2.40, P<0.001). However, no significant improvement in survival was observed (OR =1.11, 95% CI: 0.69-1.79, P=0.66). Subgroup analyses indicated the greatest reduction in MV duration for patients with weaning difficulty, and heterogeneity in ICU stay was partially explained by disease type and study quality.

CONCLUSIONS

EDP was associated with reduced MV duration, higher weaning success, and shorter ICU stay, but not with improved survival, in adult patients receiving MV. These findings support EDP as a beneficial adjunctive rehabilitation strategy, particularly for patients experiencing weaning difficulty. Further large-scale RCTs are warranted to confirm its effects on mortality and to optimize treatment protocols.