Inclusion Criteria:  Patients diagnosed septic shock in the 24 hours ensuing diagnosis:  (I) severe, refractory septic shock defined as:  an acute SOFA score increase ≥2 points consequent to a presumed or proven infection volume resuscitation of at least 30ml/kg in the last 24 hours a Vasopressor Dependency Index11 (VPI) above or equal to 3 a persistently elevated serum lactate level >2mmol/l (II) Interleukin-6 levels equal or above 1000 ng/l (III) were above 18 years of age.  Exclusion Criteria:  Contraindication on ethical grounds child bearing or breastfeeding women terminal patients human immunodeficiency virus with a CD4 cell count <0.2 106/l allergy to Polystyrene/ Divinylbenzene, Polycarbonate, Polypropylene, Silicon or Polyester need for extra-corporeal membrane oxygenation no given consent.