Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.

Findings indicate a difference in the projected service use of the bereaved experiencing depression and/or complicated grief. Follow-up screenings 6-12 months post-bereavement are recommended to identify those in need of formal psychosocial support.

In the United States, Pneumocystis jirovecii (PCP) is a leading cause of morbidity and mortality in hospitalized patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and can result in severe hypoxemia despite maximal conventional ventilator support. We present 2 adult patients with HIV/ AIDS and PCP who were managed with extracorporeal membrane oxygenation (ECMO) because of refractory hypoxemia. After prolonged hospitalization, the first patient developed multiorgan failure, and the decision was made to withdraw life support. The second patient required ECMO for 7 days and survived. We also review 2 previously published cases in which ECMO was used in adult HIV patients with severe hypoxemia from PCP. In the patients that survived, ECMO was initiated earlier in the course of hospitalization compared with those that died (mean 3.5 vs. 15 d). Furthermore, the patient that survived required a much shorter duration of ECMO support (mean 5.5 vs. 41.5 d). The use of ECMO early in the course of hospitalization can be considered in patients with HIV/AIDS and refractory hypoxemia due to PCP.

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