As ICU survival improves, researchers are exploring whether acupuncture could become a low-risk, evidence-informed add-on to critical care, helping patients recover faster while reducing reliance on heavy sedation and medications.
Study: Acupuncture for ICU patients: evidence, mechanisms, and implementation challenges. Image credit: Pictures of your Life/Shutterstock.com
Researchers have recently conducted a mini review to investigate the clinical outcome and proposed mechanisms of action of acupuncture in intensive care unit (ICU) patients. This review is available in Frontiers in Neurology.
Challenges in post-ICU recovery
Advancements in extracorporeal life support and precision monitoring have led to a significant decline in ICU mortality rates. Despite this progress, patients often experience complications, such as persistent pain, delirium, ICU-acquired weakness (ICU-AW), and gastrointestinal dysmotility, which hinder functional recovery and diminish quality of life.
Recent multicenter studies have shown that ICU-AW affects 40 to 50 % of patients, perpetuating a cycle of muscle weakness, increased infection risk, and prolonged hospitalization. In general, these patients are treated with opioids, benzodiazepines, muscle relaxants, and prokinetic agents, which can relieve symptoms but frequently cause adverse effects like respiratory depression, drug resistance, and delirium. Therefore, there is an urgent need for non-pharmacologic interventions with minimal side effects that are compatible with current monitoring technologies.
What is acupuncture?
Acupuncture is a traditional Chinese medicine practice that involves inserting fine needles into specific points on the body to alleviate pain and promote healing. It works by stimulating nerves to release natural painkillers such as endorphins, or by balancing the body's vital energy (Qi) as it flows through meridians. Contemporary clinical research focuses on neurophysiological and immunomodulatory mechanisms rather than traditional energy-based explanations.
Acupuncture is used to treat a range of conditions, including chronic pain, headaches, and nausea. Due to its multi-target regulatory effects, adaptability, and reproducibility, acupuncture has attracted increasing interest from critical care practitioners.
ICU patient management and acupuncture
Managing analgesia and sedation in mechanically ventilated patients is a complex process. Although severe illness often requires increased opioids and benzodiazepines, it raises the risks of respiratory depression, tolerance, and delirium.
Excessive sedative and analgesic use can prolong weaning, trigger delirium, and lead to ICU-AW that reduces mobility, slows recovery, lengthens hospital stays, and raises readmission rates, especially among patients requiring prolonged mechanical ventilation. Currently, clinicians recommend early maintenance of muscle strength and functional training in the ICU.
Gastrointestinal problems are common in ICU patients, ranging from constipation and gastric retention to diarrhea and increased gut permeability. These issues are often caused by a combination of illness, medications, and nutrition strategies.
The key effects of acupuncture on ICU patients are discussed below.
Analgesia and sedation
Acupuncture, particularly electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), is being increasingly explored in ICU recovery protocols. These methods may help reduce sedative and pain medication use, support ventilator management, and shorten both mechanical ventilation and ICU stays, likely due to the benefits of continuous electrical stimulation.
ICU-AW and early rehabilitation
In China, acupuncture is now commonly incorporated into ICU-AW rehabilitation programs. Early studies suggest that it may enhance 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 acupuncture may have a role in preventing and treating delirium in ICU patients by regulating neurotransmitters, reducing inflammation, and restoring circadian rhythms. Early evidence suggests that it can increase delirium-free days and lower delirium rates, although larger studies are needed to confirm these benefits.
Gastrointestinal function
Acupuncture regulates gut function by improving constipation and reducing diarrhea. Clinical studies report that acupuncture increases bowel movements and relieves opioid-induced constipation, 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 decreases sedation needs in ICU patients by activating anti-inflammatory and pain-modulating pathways. Specifically, it inhibits systemic inflammatory responses through the vagus nerve–cholinergic anti-inflammatory pathway (CAP), as shown in previous studies.
Previous studies have shown that acupuncture modulates pain signaling at multiple levels, including the peripheral, spinal, and central nervous systems, which leads to improved sedation and pain relief. Stimulation of Aδ and C fibers sends signals through the spinothalamic tract to the central nervous system, triggering the release of endorphins and enkephalins, which are natural painkillers that elevate pain thresholds and reduce stress responses.
Additionally, acupuncture increases key neurotransmitters, such as serotonin and norepinephrine, which further support pain relief and emotional stability. Collectively, these effects reduce the need for sedatives and help minimize their side effects in ICU patients.
Acupuncture also aids in hormonal balance by regulating the hypothalamic–pituitary–adrenal axis, which can help normalize the stress response and may improve immunity, muscle preservation, and neurobehavioral outcomes, such as delirium and sleep quality. This intervention enhances blood flow and tissue metabolism, supporting wound healing and muscle recovery in ICU patients. By boosting nitric oxide production, it dilates capillaries and improves nutrient delivery. Acupuncture also stimulates cellular energy processes and reduces oxidative stress, which facilitates tissue repair and protection against damage.
Previous research highlights the potential of acupuncture to restore balance to the gut microbiota. These studies suggest it can reverse antibiotic-induced imbalances, increase beneficial bacteria such as Bifidobacterium and Lactobacillus, and decrease harmful bacteria.
Conclusion and future prospects
Acupuncture offers a potentially low-risk adjunct option for intensive care, helping reduce drug dependence, support ventilator weaning, lessen ICU-AW and delirium, and improve gastrointestinal function.
These benefits, achieved through multi-pathway mechanisms, make acupuncture especially valuable when conventional therapies are limited. However, current evidence quality is limited, and acupuncture should be viewed as a complementary rather than a replacement therapy.
Future research should prioritize large-scale trials, standardization of acupuncture procedures, and the collection of long-term real-world outcome data. A deeper investigation into mechanisms, along with attention to ethical and regulatory issues, will be essential to integrating acupuncture as a standardized component of ICU care.
Download your PDF copy now!
Depression links to chronic headaches through weight and diet, not physical activity alone