Acupuncture can help patients in intensive care units recover faster.

Acupuncture can help patients in intensive care units recover faster.

As intensive care unit (ICU) survival rates improve, researchers are studying whether acupuncture could become a low-risk, evidence-based adjunct to intensive care, allowing patients to recover more quickly and reducing reliance on heavy sedation and medications.

Study: Acupuncture for ICU patients: evidence, mechanisms and implementation barriers. Image source: Pictures of your Life/Shutterstock.com

Researchers recently conducted a mini-review to examine the clinical outcomes and proposed mechanisms of action of acupuncture in intensive care patients. This review is in Frontiers in Neurology available.

Challenges in post-ICU recovery

Advances in extracorporeal life support and precise monitoring have led to significant declines in intensive care unit mortality rates. Despite this progress, patients often experience complications such as persistent pain, delirium, intensive care unit-acquired weakness (ICU-AW), and gastrointestinal dysmotility, which hinder functional recovery and reduce quality of life.

Recent multicenter studies show that ICU AW affects 40 to 50% of patients, perpetuating a vicious cycle of muscle weakness, increased risk of infection, and prolonged hospital stays. Generally, these patients are treated with opioids, benzodiazepines, muscle relaxants, and prokinetic agents, which may relieve symptoms but often cause adverse effects such as respiratory depression, drug intolerance, and delirium. Therefore, there is an urgent need for non-pharmacological interventions with minimal side effects that are compatible with current monitoring technologies.

What is acupuncture?

Acupuncture is a traditional Chinese medical practice that involves inserting fine needles into specific points on the body to relieve pain and promote healing. It works by stimulating nerves that release natural painkillers such as endorphins, or by regulating the vital energy balance (Qi) that flows through meridians. Modern clinical research focuses on neurophysiological and immunomodulatory mechanisms rather than traditional, energy-based explanations.

Acupuncture is used to treat a variety of conditions including chronic pain, headaches and nausea. Because of its versatile regulatory effects, adaptability, and reproducibility, acupuncture has attracted increasing interest among critical care professionals.

Management of ICU patients and acupuncture

Managing pain management and sedation in mechanically ventilated patients is a complex process. Although serious illnesses often require increased use of opioids and benzodiazepines, they also increase the risks of respiratory depression, tolerance, and delirium.

Excessive use of sedatives and analgesics can prolong weaning, induce delirium, and lead to ICU AW, thereby reducing mobility, slowing recovery, prolonging hospital stays, and increasing relapse rates, particularly in patients requiring long-term mechanical ventilation. Currently, clinicians recommend early muscle strength enhancement and functional training in the ICU.

Gastrointestinal problems are common in ICU patients and range from constipation and stomach enlargement to diarrhea and increased intestinal permeability. These problems are often caused by a combination of illness, medications, and nutritional strategies.

The main effects of acupuncture on ICU patients are explained below.

Pain relief and sedation

Acupuncture, particularly electroacupuncture (EA) and transcutaneous electrical acupuncture stimulation (TEAS), is increasingly being investigated in the recovery protocols of intensive care patients. These methods may help reduce the need for sedative and analgesic medications, assist in the management of ventilation, and shorten both the duration of mechanical ventilation and the length of stay in the intensive care unit, probably due to the benefits of continuous electrical stimulation.

ICU-AW and early rehabilitation

In China, acupuncture is now commonly incorporated into rehabilitation programs for ICU-AW. Early studies suggest that it may improve muscle strength, neuromuscular function and muscle mass, as well as reduce mechanical ventilation time. Larger studies are needed to confirm these benefits.

Delirium and cognitive impairment

Recent studies suggest that acupuncture may play a role in preventing and treating delirium in ICU patients by regulating neurotransmitters, reducing inflammation, and restoring circadian rhythms. Early evidence shows that it may increase the number of delirium-free days and reduce delirium rates, although larger studies are needed to confirm these benefits.

Gastrointestinal function

Acupuncture regulates bowel function by improving constipation and reducing diarrhea. Clinical studies report that acupuncture increases bowel movements and relieves constipation caused by opioids, while also reducing the incidence of diarrhea in patients receiving enteral nutrition.

Mechanisms of action of acupuncture in ICU patients

Acupuncture reduces inflammation, relieves pain and reduces the need for sedation in ICU patients by anti-inflammatory and pain-relieving pathways activated. In particular, it inhibits systemic inflammatory responses via the vagal nerve and the cholinergic anti-inflammatory pathway (CAP), as previous studies have shown.

Previous studies have shown that acupuncture modulates pain signaling at multiple levels, including the peripheral, spinal, and central nervous systems, resulting in improved sedation and pain relief. Stimulation of Aδ and C fibers sends signals to the central one via the spinothalamic tract Nervous system, triggering the release of endorphins and enkephalins, which are natural painkillers that increase pain thresholds and reduce stress responses.

Additionally, acupuncture increases important neurotransmitters such as serotonin and norepinephrine, which provide further support in pain relief and emotional stability. Together, these effects reduce the need for sedatives and help minimize their side effects in ICU patients.

Acupuncture also helps regulate hormonal balance by affecting the hypothalamic-pituitary-adrenal axis, which can help normalize the stress response and improve immunity, muscle protection, and neurobehavioral outcomes such as delirium and sleep quality. This intervention promotes blood flow and tissue metabolism, which supports wound healing and muscle regeneration in ICU patients. By increasing nitric oxide production, it expands the capillaries and improves nutrient supply. Acupuncture also stimulates cellular energy processes and reduces oxidative stress, facilitating tissue repair and protection from damage.

Previous research shows the potential of acupuncture to restore the balance of the gut microbiota. These studies suggest that it can reverse antibiotic-induced imbalances, increase beneficial bacteria such as Bifidobacterium and Lactobacillus, and decrease harmful bacteria.

Conclusion and future perspectives

Acupuncture offers a potentially low-risk adjunct to critical care by reducing medication dependence, assisting in weaning from ventilators, reducing ICU AW and delirium, and improving gastrointestinal functions.

These benefits, achieved through mechanisms in multiple pathways, make acupuncture particularly valuable when conventional therapies are limited. However, the current quality of evidence is limited and acupuncture should be considered as a complementary rather than a replacement therapy.

Future research should prioritize large studies, develop standardized acupuncture procedures, and collect long-term, real-time outcome data. A deeper study of the mechanisms, along with consideration of ethical and regulatory issues, will be crucial to incorporating acupuncture as a standardized component of ICU care.

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