Therapeutic Plasma Exchange in Septic Shock: A Pilot Study

Eligible patients must be admitted to an ICU and must meet all of the following inclusion criteria: 1. ≥ 16 years of age 2. Refractory hypotension documented within 48 hours prior to enrollment requiring the institution and ongoing use of vasopressor agents (phenylephrine, norepinephrine, vasopressin, epinephrine, midodrine or dopamine \>5 mcg/kg/min) at enrollment. Refractory hypotension is defined as a systolic blood pressure (SBP) less than 90 mmHg, or SBP less than 30 mmHg below baseline, or a mean arterial blood pressure less than 65 mmHg, despite adequate fluid resuscitation 3. Capacity to initiate plasma exchange with 48 hours of vasopressor initiation. 4. At least 1 other new organ dysfunction (in addition to refractory hypotension), defined by the following at the time of enrollment: 1. Creatinine ≥1.5x the known baseline creatinine within 7 days, or ≥ 26.5 µmol/l increase in 48 hours, 2. Need for invasive mechanical ventilation or a P/F ratio \<250 3. Platelets \<100 x109/L, or a drop of 50 x109/L in the 3 days prior to enrollment 4. Arterial pH \< 7.30 or base deficit \> 5 mmol/L in association with a lactate \>/= to 3.0 mmol/L 45\. Known or suspected infection 2.4.3 Exclusion criteria We will exclude patients who have any one of the following criteria at the time of enrollment: 1. Consent declined (refusal from patient, SDM, or physician) 2. Clinically apparent alternate causes for shock (cardiogenic, hemorrhagic, obstructive, neurogenic or anaphylactic) 3. Terminal illness with a life expectancy of less than 3 months 4. Are pregnant