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Abstract

Background & objectives: Snakebite envenomation remains a significant cause of morbidity and mortality in tropical and subtropical regions. The existing literature on the critical care management of severe envenomation cases is insufficient, despite the considerable interest in public health strategies and antivenom utilization.
This narrative review aims to provide a comprehensive overview of the pathophysiological characteristics of severe snakebite envenomation requiring ICU admission and to emphasize current evidence-based strategies for critical care management.
Methodology: A narrative review was conducted using literature sourced from PubMed, Scopus, and Web of Science. Search terms included “snakebite,” “envenomation,” “intensive care,” “critical care,” “neurotoxicity,” “coagulopathy,” “renal failure,” and “organ support.” Inclusion criteria comprised clinical trials, observational studies, and expert guidelines focused on ICU-level management of snakebite envenomation. Exclusion criteria included non-English articles, studies unrelated to critical care, and those lacking original clinical data. An informal critical appraisal prioritized high-quality studies based on methodological clarity, sample size, and relevance to both high- and low-resource settings.
Results: Literature indicates that severe envenomation can result in coagulopathy, acute kidney injury, shock, secondary infections, rapid onset of neurotoxicity, respiratory paralysis, and other conditions, all necessitating ICU-level treatment. Timely antivenom delivery is essential; however, it must be complemented by continuous hemodynamic monitoring, mechanical ventilation, vasopressor therapy, renal replacement therapy, and infection control strategies.
Conclusions: Snakebite envenomation poses complex challenges that extend beyond the availability of antivenom. Severe cases necessitate critical care intervention to avert permanent organ damage and reduce mortality. Enhancing outcomes for snakebite victims necessitates a proper integration of the ICU protocols, physician education, and the development of infrastructure, particularly in endemic regions. Future studies should aim to evaluate standardized ICU management pathways, investigate long-term outcomes in envenomated patients, and address regional disparities in critical care capacity to inform more equitable and effective care delivery.
Abbreviations: AKI: acute kidney injury, ARDS: acute respiratory distress syndrome, CK: creatine kinase, DIC: disseminated intravascular coagulation, ICU: intensive care unit, MFO: Multiorgan failure, SBE: Snakebite envenomation, SIRS: systemic inflammatory response syndrome, TSS: Toxic snakebite syndrome, VICC: venom-induced consumption coagulopathy
Keywords: Snakebite Envenomation; Intensive Care; Critical Care Management; Neurotoxicity; Coagulopathy; Organ Support
Citation: Elmorsy EM, Syed A, Chatha WA, Agarwal A, Shah SSH, Al-rawili SAH, Alanzy SFB, ASA, Alanazi ASA, Almafadhilah SFS, Critical care management of snakebite envenomation: An overlooked frontier in the intensive care. Anaesth. pain intensive care 2025;29(5):382-392. DOI: 10.35975/apic.v29i5.2870
Received: June 11, 2025; Revised: July 02, 2025; Accepted: July 14, 2025