Final answer:
Patients with COPD are at the greatest risk of developing auto-PEEP during mechanical ventilation due to the decreased lung elasticity, airway obstruction, and air trapping characteristic of this condition.
Step-by-step explanation:
Patients with chronic obstructive pulmonary disease (COPD) are at the greatest risk for developing auto-PEEP (positive end-expiratory pressure) during mechanical ventilation. COPD is characterized by a loss of elasticity in the lungs and destruction of alveoli, resulting in trapped air at the end of exhalation. The lack of elastic recoil and increased airway resistance leads to difficulty in fully exhaling before the next breath begins, which can result in the inadvertent buildup of pressure within the lungs known as auto-PEEP.
While patients with acute lung injury, congestive heart failure, or bilateral pneumonia may also face challenges with mechanical ventilation, it is the nature of COPD's airway obstruction and the tendency to trap air that most directly contributes to the development of auto-PEEP.