Therapeutic Plasma Exchange in Septic Shock: a Pilot Study

Conditions de participation

• Sexe:

  ALL

• Âges admissibles:

  16 and up

Critères de participation

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 24 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. At least 1 other new organ dysfunction (in addition to refractory hypotension), defined by the following at the time of enrollment:

a.) Creatinine ≥1.5x the known baseline creatinine, or ≥ 26.5 µmol/l increase, b.) Need for invasive mechanical ventilation or a P/F ratio \<250 c.) Platelets \<100 x109/L, or a drop of 50 x109/L in the 3 days prior to enrollment d.) Arterial pH \< 7.30 or base deficit \> 5 mmol/L in association with a lactate \>/= to 3.0 mmol/L
4. Known or suspected infection

Exclusion Criteria:

Patients who have any one of the following criteria at the time of enrollment will be excluded:

1. Consent declined (refusal from patient, SDM, or physician)
2. Clinically apparent alternate causes for shock (cardiogenic, hemorrhagic, obstructive, neurogenic or anaphylactic)
3. Received vasopressor therapy for greater than 24 hours prior to enrollment
4. Terminal illness with a life expectancy of less than 3 months
5. Are pregnant