Transcutaneous Electrical Diaphragmatic Stimulation in Prolonged Mechanical Ventilation: A Systematic Review and Meta-analysis

Background: Prolonged mechanical ventilation can lead to diaphragmatic dysfunction, contributing to difficult weaning and poor outcomes in critically ill patients. Transcutaneous electrical diaphragmatic stimulation (TEDS) has been proposed as a noninvasive approach to preserve diaphragm function and support weaning. Aim: To determine whether TEDS improves clinical outcomes and diaphragm function in mechanically ventilated adults. Methods:This meta-analysis followed PRISMA and Cochrane guidelines. A systematic search of PubMed, Scopus and the Cochrane Library was conducted to identify randomized controlled trials (RCTs) comparing TEDS with standard care in mechanically ventilated adults, covering publications up to September, 2025. Results: Five RCTs including 324 patients were included. TEDS significantly reduced the duration of mechanical ventilation (mean differece [MD]=–1.78 days;95%CI [–2.90,–0.66];p=0.002;I²=47%) and ICU length of stay (MD=–1.61 days;95%CI [–2.31, –0.91];p< 0.00001;I² =0%). TEDS also led to a significant improvement in diaphragm thickening fraction (MD=1.59; 95%CI [0.74,2.43];p=0.0002;I²=6%). No significant difference was observed in weaning success rates (odds ratio [OR]=2.47; 95%CI[0.42–14.44];p=0.32;I²=70%), although a favorable trend toward higher weaning success with TEDS was noted. Conclusion: TEDS appears to be an effective intervention in critically ill patients, reducing mechanical ventilation duration and ICU stay while enhancing diaphragmatic function. Its effect on weaning success remains uncertain, but these findings support TEDS as a promising noninvasive adjunct therapy.