Acupuncture in the ICU

Stimulated by Ben-Arie et al 2023.[1]

ICU – intensive care unit
SR – systematic review
AEs – adverse events
GRADE – grading of recommendations, assessment, development, and evaluation

key to acronyms

I was thinking of highlighting this SR on the safety of acupuncture in the ICU, but then I saw that the lead author was presenting at a conference I was due to attend in Rome. So, I waited, thinking I could discuss the paper face to face and gain more insights. Consequently, I marched confidently up to Professor E Ben-Arye before he was due to present on the big stage in the Angelicum Conference Centre, Rome. He was very polite but denied all knowledge of the paper. He said “…but I don’t work in ICU. I am a professor of oncology.” I apologised and returned to my seat, somewhat surprised, and confused. The first author of the paper was E Ben-Arie, and his affiliation was in Taiwan rather than Israel – presumably he travelled there to study acupuncture and is unrelated to the professor I accosted.

I was surprised to see this review coming relatively soon after the one we published in Acupuncture in Medicine, which I highlighted here: Acupuncture and reduced mortality.[2] This review was published online in May 2022, but did not reach an issue until Feb 2023. I was also a little surprised to see that it was not referenced in the current paper.

There is marginally more data in the current review, and the scope is broader, so it is certainly justified. I was first attracted by the 28-day mortality outcome, but this was not the key focus of the paper, which was safety.

They include minor AEs and adverse reactions as well as the length of ICU stay and 28-day mortality. It is not clear what the difference is between minor AEs and adverse reactions, but I guess this was due to the descriptions in the original papers, since hypotension and nausea appear in both categories. Importantly, in the supplement of the paper, they pool the data for both, which seems to me to be the most sensible approach.

There was no difference when the 2 items were combined, although adverse reactions alone seemed to favour acupuncture groups ie ICU care alone was associated with more adverse reactions. I guess it is conceivable that acupuncture was protective to some degree considering the nature of medical care in ICU.

ICU stay was shorter in the acupuncture groups, although this was only by 1 to 2 days and with a very low level of certainty using GRADE.

The most encouraging outcome was 28-day mortality, which was slightly better than that previously reported here. 1335 patients from 10 trials were included in the meta-analysis and the result favoured acupuncture with an odds ratio of 0.61 and no heterogeneity. That is almost a 40% reduction in mortality and the authors quote a moderate level of certainty on GRADE.

References

1          Ben-Arie E, Lottering BJ, Chen F-P, et al. Is acupuncture safe in the ICU? A systematic review and meta-analysis. Front Med. 2023;10:1190635.

2          Xian J, Wang L, Zhang C, et al. Efficacy and safety of acupuncture as a complementary therapy for sepsis: a systematic review and meta-analysis. Acupunct Med. 2023;41:3–15.

---

Declaration of interests MC