Summary We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2.0%). Intensive care unit admission following surgery (333/1431; 23.3%), medical conditions (327/1431; 22.9%) and traumatic brain injury (233/1431; 16.3%) caused the highest number of deaths. Of all deaths in the hospital, (1431/11,357; 12.6%) occurred in the intensive care unit. Although the proportion of hospitalised patients admitted to the intensive care unit increased over time, from 0.7% in 2005/6 to 2.8% in 2013/4 (p < 0.001), overall hospital mortality decreased (2005/6, 4.8%; 2013/14, 4.0%; p < 0.001). The proportion of intensive care patients whose lungs were mechanically ventilated was 18.7% (961/5147). This subgroup of patients did not change over time (2006, 16%; 2015, 18.4%; p = 0.12), but their mortality decreased (2006, 59.5%; 2015, 44.3%; p < 0.001).

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Approximately 5.4 million people are bitten by snakes annually, with up to half of these victims experiencing signs of envenomation. This results in an estimated 138 000 deaths per year. [1] Only limited data exist on the long-term morbidity of snakebites, but one study suggested that between 5 900 and 14 600 amputations per year may be attributed to snakebites in sub-Saharan Africa (sSA) alone. [2] However, accuracy of epidemiological data is limited owing to under-reporting, patients' poor access to healthcare facilities and many victims attending traditional healers rather than health centres or hospitals. [1][2][3] The burden of snakebites is unevenly distributed across the globe, with 95% of cases encountered in low-and middle-income countries in Africa and Asia. [4,5] Even in those areas, the health effects of snakebites are disproportional, with the poorest of the poor generally experiencing poor outcomes. [6,7] Rural sSA is specifically vulnerable owing to limited availability of healthcare services. In 2017, the World Health Organization (WHO) recognised snakebite envenoming as a neglected tropical disease. [7] Accordingly, snakebite antivenoms are included in the WHO's list of essential medicines. [8] Common acute medical conditions arising from snakebites depend on the species, but include neurotoxicity, coagulation failure accompanied by shock or organ dysfunction, and local tissue destruction. [9] Multiple factors, including delayed presentation to healthcare facilities, adversely affect the management and outcome of snakebite victims. [2] Inadequate regulatory frameworks that result in ineffective or unsafe antivenom products being available, restricted access and high costs are crucial challenges limiting the use of antivenoms, particularly in sSA. [10,11] Supportive measures are often the only therapeutic options for patients presenting with snakebite envenoming in sSA.In this study, we report the intensive care unit (ICU) management and outcomes of 174 snakebite victims who were treated mainly with basic intensive-care interventions (e.g. mechanical ventilation) in a rural sSA hospital where adequate doses of antivenom were not available.