Abstract
<title>Abstract</title> <p> <bold>Background</bold> Timely access to intensive care is a critical determinant of outcomes among patients with life-threatening illness. Although Colombia has expanded intensive care unit (ICU) capacity in recent years, the extent to which the population can reach different ICU subtypes within operationally relevant timeframes remains unknown. This study evaluated travel-time accessibility to intensive care services in Colombia and identified priority areas for the expansion of the critical care network. <bold>Methods</bold> A national cross-sectional geospatial analysis was conducted using validated ICU facility locations, a harmonized high-resolution population surface, and least-cost path modeling based on the national road network. Travel-time accessibility was estimated for adult, neonatal, pediatric, and burn ICUs. Population coverage was quantified across predefined travel-time intervals. Model validity was assessed using 32 ambulance-reported referral routes. Priority expansion zones were identified using a travel-time threshold of > 60 minutes and a minimum catchment population of 25,000 inhabitants. <bold>Results</bold> Marked disparities in accessibility were observed across ICU subtypes. Adult ICUs showed the broadest coverage, with 76.5% of the population reached within 120 minutes and 23.5% above this threshold. Access to specialized services was more restricted: 51.0% of the population lived more than 120 minutes from neonatal ICUs, 34.5% from pediatric ICUs, and approximately 65% from burn units. The validation results showed strong agreement between the modeled and observed travel times (r = 0.99), with a mean absolute error of 24.3 ± 49.6 minutes. A total of 45–137 priority expansion zones were identified, depending on the ICU subtype. <bold>Conclusions</bold> Geographic access to intensive care in Colombia remains substantially constrained, particularly for neonatal, pediatric, and burn services. Installed ICU capacity overestimates functional access to care. Travel-time analysis provides a policy-relevant framework to guide ICU network optimization, referral system strengthening, and targeted expansion of critical care services in geographically heterogeneous settings. </p>