Effect of Diaphragmatic Neuromuscular Electrical Stimulation on Diaphragm Function and Clinical Outcomes in ICU Mechanically Ventilated Patients

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.