Stimulated by Ben-Arie et al 2024.[1]
ICU – intensive care unit
key to acronyms
SR – systematic review
MV – mechanical ventilation
RCT – randomised controlled trial
EA – electroacupuncture
MA – manual acupuncture
US – ultrasound
RR – relative risk
CI – confidence interval
This paper was published online in November 2023, but I could not access the full text. Eventually I wrote to one of the corresponding authors (Yu-Chen Lee) and he kindly sent me a pdf.
It is another SR based on trials of patients in ICU from the same team in Taichung, Taiwan, as the one I highlighted on the safety of acupuncture in this setting: Acupuncture in the ICU (2023).[2] This one is essentially a subset of the trials in the first SR, which focusses on patients that were subject to mechanical ventilation (MV). They included 10 trials as opposed to 31 in their previous SR on safety. One of the ten did not appear in the previous SR and I guess it was missed by the broader search criteria – it mentions mechanical ventilation in the title but not ICU.[3]
The first SR with a mortality outcome in humans focused on patients with sepsis and included 17 trials. It was published online in Acupuncture in Medicine in May 2022, and I highlighted it here: Acupuncture and reduced mortality.[4] This review was performed by a group from Jinan, Shandong, China – a city lying just south of the Yellow river. Less than half the trials in this SR were included in the larger SR on safety, again presumably mainly due to differences in search strategies.
The current SR included 754 critically ill patients undergoing MV in ICU (10 RCTs). 6 of the trials used EA (2 of these also used Chinese herbs), 2 used MA, one used press needles and one used something translated as “US guided electrical acupoint stimulation”. I was not able to find out whether or not this last one used needles or not. I guess it did, otherwise what is the point of using US?
The controls were usually routine ICU care alone. The active treatment groups also got this as well, of course, some most trials were an A+B vs B design. 2 used needling in the control – gentle MA in one of the EA trials and inappropriate points in a trial of MA for feeding intolerance following oropharyngeal surgery for cancer. The latter trial report has the same first author as this SR.
5 of the 10 RCTs had data on MV days that could be pooled. The acupuncture groups had MV for 2 days less than control, which corresponds to about a 20% reduction in total MV time.
9 trials reported total days in ICU. This was reduced by just over 1 day, but the clinical heterogeneity was such that the range of total ICU days varied from 2 to 22.
Finally, 8 trials reported mortality outcomes, but in 3 of those there was no mortality in either of the groups. 3 trials reported 28-day mortality and there was a trend in favour of acupuncture (RR 0.78) but the CI crossed the line (RR 0.51 to 1.19). The authors chose to pool a fourth trial in a meta-analysis of total mortality. This was significant with an RR of 0.67, ie a reduction in mortality of 33%. This is compatible with previous estimates and there was no statistical heterogeneity. I note that one other trial had data for total mortality that could have been included. This was a trial on patients undergoing abdominal surgery and there was a single case of mortality in each group, although the control group was slightly larger (28 vs 25). If this had been included in the meta-analysis on total mortality it would not have changed the result by much.
References
1 Ben-Arie E, Mayer PK, Lottering BJ, et al. Acupuncture reduces mechanical ventilation time in critically ill patients: A systematic review and meta-analysis of randomized control trials. Explore. 2023;S1550-8307(23)00266-5.
2 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.
3 Yuan S-C, Cao W-J, Huang Y, et al. [Effect of acupuncture on analgesia and sedation in elderly patients with severe pneumonia during invasive mechanical ventilation]. Zhongguo Zhen Jiu. 2021;41:971–8.
4 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.
The BMAS Blog 
You must be logged in to post a comment.