a) significant traumatic brain injury (evidence of neurologic injury on CT scan and a GCS <8), b) refractory shock (likely death within 12 hours), c) alternative/confounding diagnosis causing shock (e.g., myocardial infarction or pulmonary embolus), d) uncontrollable source of sepsis (e.g., irreversible disease state such as unresectable dead bowel), e) patients deemed futile care or have advanced directives limiting resuscitative efforts, f) severe CHF (NY Heart Association Class IV), g) Child-Pugh Class B or C liver disease, h) known HIV with CD4 count <200 cells/mm3, i) organ transplant recipient on immunosuppressive agents, j) known pregnancy, k) inability to obtain informed consent, and l) diagnosed disorders of lipid metabolism.