{
  "abstract": "Background\n\nDespite long-standing clinical use and emerging evidence, no structured framework exists guiding clinicians in identifying septic shock patients for endotoxemia assessment, interpretation of the Endotoxin Activity Assay (EAA), or practical implementation of polymyxin B hemoadsorption (PMX-HA) therapy.Methods\n\nA modified Delphi consensus process was conducted with ten critical care and nephrology experts, compromising a pre-meeting survey, a one-day in-person consensus conference, and iterative voting on draft statements. Consensus was predefined as ≥ 80% agreement.Results\n\nConsensus was achieved on 20 statements across three domains: (1) operational criteria to prompt endotoxemia assessment in suspected or presumed septic shock, (2) role and interpretation of the EAA, and (3) logistics and clinical implementation of PMX-HA. Key recommendations included standardized criteria to identify eligible patients, EAA thresholds of ≥ 0.60 and < 0.90 to support PMX‑HA consideration, initiation of therapy as early as possible once eligibility is confirmed, with ≤ 36 h from septic shock onset proposed as a pragmatic implementation benchmark, and standardized treatment protocols consisting of two sessions, 24 h apart, targeting 120 min each. A multidisciplinary team model was endorsed for implementation. Identified research priorities were in treatment effect heterogeneity, EAA kinetics, clinical implementation, and healthcare system integration.Conclusions\n\nThese consensus recommendations provide a structured, implementation-focused framework for PMX-HA use in suspected endotoxic shock. The framework emphasizes stepwise operational criteria, biomarker-guided decision-making, multidisciplinary team-based implementation, and standardized protocols. It is intended to support institutions currently using PMX-HA and to assist U.S. clinicians and health systems in preparing for potential adoption pending regulatory approval.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Nephrology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr. 5364, Ann Arbor, 48109, MI, USA. lenar@med.umich.edu.",
    "Department of Anesthesiology, Critical Care and Pain Medicine, University of California San Francisco, San Francisco, CA, USA.",
    "Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.",
    "Department of Anaesthesiology and Critical Care, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.",
    "Division of Pulmonary and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA.",
    "Division of Nephrology and Hypertension, Medical University of South Carolina, Charleston, SC, USA.",
    "Division of Pulmonary and Critical Care Medicine, Louisiana State University Health, Shreveport, LA, USA.",
    "UCHealth Memorial Central Hospital, Colorado Springs, CO, USA."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lenar Yessayan"
    },
    {
      "affs": [
        1
      ],
      "name": "Matthieu Legrand"
    },
    {
      "affs": [
        2
      ],
      "name": "Javier A Neyra"
    },
    {
      "affs": [
        3
      ],
      "name": "Danielle Davison"
    },
    {
      "affs": [
        4
      ],
      "name": "Laurence W Busse"
    },
    {
      "affs": [
        4
      ],
      "name": "William S Bender"
    },
    {
      "affs": [
        5
      ],
      "name": "Blaithin A McMahon"
    },
    {
      "affs": [
        6
      ],
      "name": "Jonathan Eaton"
    },
    {
      "affs": [
        7
      ],
      "name": "Tara Morgan-Gray"
    },
    {
      "affs": [
        7
      ],
      "name": "Cindy Ramberg"
    },
    {
      "affs": [
        2
      ],
      "name": "Ashita Tolwani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c4946z3pk02k1.bib",
  "cited_by": 0,
  "doi": "10.1186/s13054-026-06182-8",
  "fulltext_url": "https://europepmc.org/articles/PMC13700435",
  "id": "c4946z3pk02k1",
  "issns": [
    "1364-8535",
    "1466-609X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42928302",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7171626635",
  "pdf_url": "https://europepmc.org/articles/PMC13700435?pdf=render",
  "pmcid": "PMC13700435",
  "pmid": "42928302",
  "published": "2026-07-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c4946z3pk02k1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:20Z",
      "native_id": "MED:42928302",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42928302"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Sepsis Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Consensus recommendations for patient selection and clinical implementation of polymyxin B hemoadsorption in endotoxic septic shock.",
  "title_text": "Consensus recommendations for patient selection and clinical implementation of polymyxin B hemoadsorption in endotoxic septic shock.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:20Z",
  "url": "https://research.draconitic.com/paper/c4946z3pk02k1",
  "venue": "Critical care (London, England)",
  "versions": []
}