Acupuncture for ICU patients: evidence, mechanisms, and implementation challenges

Objective: To explore the clinical applications, mechanisms of action, and methodological and implementation challenges of acupuncture in intensive care unit (ICU) patients, to provide a theoretical foundation for its standardization and evidence-based advancement. Methods: A comprehensive analysis of recent clinical studies, mechanistic investigations, and consensus guidelines regarding acupuncture use among ICU patients was conducted. The review summarizes its efficacy in analgesia and sedation, ICU-acquired weakness (ICU-AW), delirium, and gastrointestinal dysfunction, while systematically addressing aspects of infection control, procedural standardization, and research design. Results: Multiple randomized controlled trials (RCTs) and systematic reviews indicate that acupuncture interventions can effectively reduce reliance on analgesic and sedative medications, shorten the duration of mechanical ventilation and ICU stay, reduce the incidence of ICU-AW and delirium, and improve gastrointestinal motility. Mechanistic studies suggest that acupuncture exerts its effects via several pathways, including activation of the vagus nerve-cholinergic anti-inflammatory reflex, modulation of central analgesic networks, restoration of hypothalamic-pituitary-adrenal (HPA) axis homeostasis, and enhancement of microcirculation. However, clinical implementation remains limited by infection-control concerns, procedural heterogeneity, and the overall low quality of evidence. Conclusion: Current evidence indicates that acupuncture is generally safe and exerts multisystem regulatory effects in ICU patients, supporting its potential as a complementary therapy in critical care. Nevertheless, its role should be further validated through rigorous multicenter trials, standardized operational frameworks, and strict aseptic protocols prior to its incorporation into routine ICU practice.