1. Intubated and mechanically ventilated at baseline 2. Receiving extracorporeal membrane oxygenation (ECMO) at baseline 3. Severe organ dysfunction (SOFA score > 10) 4. Patient or LAR unable to provide written informed consent 5. ALT/AST > 5 times the upper limit of normal. 6. Stage 3 (EGFR by MDRD) severe chronic kidney disease or requiring dialysis (i.e. eGFR < 30) 7. Pregnancy or breast feeding. 8. Anticipated transfer to another hospital which is not a study site within 72 hours. 9. Allergy to any study medication 10. Moribund patient not expected to survive 24 hours

1. Intubated and mechanically ventilated at baseline 2. Receiving extracorporeal membrane oxygenation (ECMO) at baseline 3. Severe organ dysfunction (SOFA score > 10) 4. Patient or LAR unable to provide written informed consent 5. ALT/AST > 5 times the upper limit of normal. 6. Stage 3 (EGFR by MDRD) severe chronic kidney disease or requiring dialysis (i.e. eGFR < 30) 7. Pregnancy or breast feeding. 8. Anticipated transfer to another hospital which is not a study site within 72 hours. 9. Allergy to any study medication 10. Moribund patient not expected to survive 24 hours