A 65-Year-Old Woman with Chronic Obstructive Pulmonary Disease Comes to the Emergency

A 65-year-old woman with chronic obstructive pulmonary disease comes to the emergency department due to worsening shortness of breath and cough. She has a mild productive cough for the past 2 years but she noticed that her sputum is more yellow than usual over the past 2 days. She has not had any recent fevers, chills, sore throat, or a runny nose. Her only medication is a salmeterol inhaler that she uses twice daily. Pulse oximetry shows an oxygen saturation of 85% on room air. Expiratory wheezes are heard throughout the lungs.  The patient is started on high-flow oxygen supplementation.  Shortly afterward, she becomes increasingly lethargic and confused.  This patient's clinical decline is most likely attributable to an increase in which of the following parameters?

A) Pulmonary vascular resistance
B) Reactive oxygen species production
C) Renal bicarbonate reabsorption
D) Respiratory minute ventilation
E) Ventilation-perfusion mismatch

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