Endotoxin Adsorber Hemoperfusion and Microcirculation

Inclusion Criteria:

Patients will be included in this study if they meet the following criteria (A+B+C):

A. Patients with clear or suspected infection by gram-negative bacteria. The presence of at least one of these two conditions:

1. Abdominal cavity infection following emergency surgery.
2. Infection with clear evidence (previous culture) or high suspicion (smear report) of gram-negative bacteria.

B. SIRS, as defined by the presence of at least 2 of the following conditions (These criteria should have occurred between 12 hours before or 6 hours after the onset of the qualifying first organ dysfunction :

1. Fever or hypothermia (body temperature over 38 ℃ or under 36 ℃)
2. Tachycardia (heart rate > 90 bpm)
3. Tachypnea (respiratory rate over 20 breaths/min or under mechanical ventilation)
4. Leukocyte count more than 12,000 cells/mm3, less than 4,000 cells/mm3, or more than 10 % of immature form (band)

C. The presence of at least one of these symptoms of organ dysfunction or shock:

1. Cardiovascular system: an SBP of less than 90 mm Hg, a decrease in SBP of at least 40 mm Hg from baseline, a MAP of less than 65 mm Hg, or that requires treatments with vasoactive medication at any dosage.
2. Acute lung injury: PaO2 / FiO2 ratio less than 300 (ratio in mm Hg)
3. Acute kidney injury: creatinine more than 2 mg/dL, an increase in creatinine of more than 0.5 mg/dL, or diuresis of less than 0.5 mL/kg/h for 2 hours.
4. Acute liver injury: Total bilirubin level more than 4 mg/dL
5. Disseminated intravascular coagulation: platelet count less than 100,000 cells/mm3 or a reduction of more than 50 % of baseline
6. Altered mental status: GCS under 13 or 9T under endotracheal tube
7. Lactic acidosis: Lactate level more than 2 mmol/L (accompany with pH < 7.3 or Base excess < -5 mmol/L)

Exclusion Criteria:

Patients will be excluded if they A. are under 20 years old or older than 99 years old B. have suffered from severe sepsis or septic shock more than 24 hours C. are pregnant D. were treated with another medicine or device in the trial less than 30 days prior to the admission to this trial E. have received organ transplantation less than 1 years prior to this trial F have a allergic history of polymyxin B, heparin, or extracorporeal circulation G. are terminally ill, for examples with metastasis, with a life expectancy of less than 30 days (certified by the attending physician) H. have been diagnosed with HIV I. present uncontrolled bleeding in the last 24 hours J. were diagnosed with leukocytopenia (leukocyte count less than 500 cell/mm3) and/or thrombocytopenia (platelet count less than 50,000 cells/mm3) K. have already received other blood cleaning treatments, such as CVVH, HD, HF, and PE upon entry into the trial L. have a prior history of severe chronic organ failure

1. chronic respiratory failure ( COPD at last stage)
2. chronic heart failure (NYHA score = IV)
3. brain death
4. Chronic liver failure (Child Pugh score: C) M. have evidence of infection by gram-positive bacteria, fungal infection, or mixed infection N. have chosen palliative care and signed Do Not Resuscitate sheet O. an APACHE II score over 30 or under 15 present on entry into the trial