A 65-Year-Old Man with Chronic Obstructive Pulmonary Disease Is Hospitalized

A 65-year-old man with chronic obstructive pulmonary disease is hospitalized due to worsening shortness of breath, coughing, and wheezing.  On arrival to the emergency department, the patient was in severe respiratory distress with bilateral wheezing.  Chest x-ray revealed hyperinflated lungs without infiltrates.  Endotracheal intubation was performed and mechanical ventilation initiated.  Inhaled bronchodilators, systemic glucocorticoids, and empiric antibiotics were administered.  Respiratory status gradually improved, and the patient was admitted to the intensive care unit.  Now, 45 minutes later, progressive hypoxemia with elevated peak and plateau pressures has developed.  Blood pressure is 150/86 mm Hg, pulse is 108/min, and respirations are 22/min.  Oxygen saturation is 88% despite an increase in the fraction of inspired oxygen (FiO₂) to 70%.  There is no wheezing, but breath sounds are decreased on the right.  Tracheal suctioning yields no mucus.  Which of the following is the most likely cause of the deterioration in this patient's condition?

A) Acute respiratory distress syndrome
B) Pneumothorax
C) Pulmonary embolism
D) Right mainstem bronchus intubation
E) Ventilator-associated pneumonia

Correct Answer:

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