UpToDate — "Oxygen-induced hypercapnia in COPD":
"The primary mechanism is worsening of ventilation-perfusion mismatch due to the loss of hypoxic pulmonary vasoconstriction. This leads to increased perfusion of poorly ventilated alveoli (i.e., low V/Q units), reducing CO₂ elimination."
West JB, Respiratory Physiology (10th ed.):
“The increase in CO₂ is primarily due to the increased perfusion of lung units with low ventilation-perfusion ratios.”
Aubier et al., NEJM, 1980:
O₂ administration worsens hypercapnia by impairing V/Q matching, particularly through increased low V/Q regions, not dead space.
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