Total hypothermic blood exchange in acute endotoxin shock

It has been reported that total hypothermic blood exchange holds promise for the treatment of septic shock in animals. Since this procedure does not carry any mortality in out laboratory, we studied its effect in an acute septic shock model. After the intravenous injection of endotoxin (10 mg/kg) and blood transfusions into 33 dogs, severe haemoconcentration, tachypnoea, tachycardia, low cardiac output, metabolic acidosis and hyperpyrexia led uniformly to death within 5 h. All of these symptoms were prevented in five dogs by total hypothermic blood exchange, instituted 5 min after the endotoxin injection. Nevertheless, all of these treated animals died a delayed death. Since the endotoxin particles are rapidly phagocytosed by the reticulo-endothelial system, even very early total blood exchange cannot dislodge them from their intracellular site.