Is there a Starling curve for intensive care?

Area of Science:

• Critical Care Medicine
• Health Services Research
• Public Health Policy

Background:

• Significant global disparities exist in the number of intensive care unit (ICU) beds.
• The optimal number of ICU beds involves balancing potential benefits and harms for a population.

Purpose of the Study:

• To examine the societal implications of both insufficient and excessive ICU bed availability.
• To propose a conceptual framework for understanding the relationship between ICU bed numbers and patient/societal outcomes.

Main Methods:

• This commentary reviews existing literature and concepts related to ICU bed provision.
• It utilizes the analogy of the Starling curve to illustrate potential harms of oversupply.

Main Results:

• Insufficient ICU beds can lead to delayed or denied admissions, increasing mortality.
• An excess of ICU beds may result in increased healthcare costs, futile care, and iatrogenic complications.

Conclusions:

• The relationship between ICU bed availability and patient outcomes is complex, not linear.
• A "family of Starling curves" is proposed to conceptualize the optimal balance between ICU bed supply and societal benefit, minimizing harm.