Sepsis and its complications remain the principal cause of death in intensive care units, and is associated with high costs. Protocolized care of septic shock has however lately been associated with decreased death rates, but to date there is still no specific treatment for sepsis. Pharmacologic therapies aiming at blocking the action of bacterial endotoxin or its receptor have been largely disappointing. Epuration of circulating endotoxin using hemoadsorption on polymyxin columns is a new treatment in septic shock showing encouraging preliminary results. Studies reporting such results, and hypotheses for a potential beneficial effect of this type of therapy are discussed in this article.