Multiorgan Ultrasound Model Predicts 48-Hour Extubation Failure: Multicenter Prospective study

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 18

Ivan Huespe, MD

Buenos Aires, Argentina

Disclosure(s): No relevant financial relationship(s) to disclose.
IF

Ignacio Fernández Ceballos, n/a

MD
Hospital Italiano de Buenos Aires, Argentina

Disclosure information not submitted.
LB

Lucía A. Bertorello, N/A

MD
Hospital Alemán de Buenos Aires, Buenos Aires, Argentina

Disclosure information not submitted.
MK

María Mercedes Kleinert, n/a

MD
Hospital Alemán de Buenos Aires, Argentina

Disclosure information not submitted.
AG

Alicia Gira, n/a

MD
Hospital Austral, Argentina

Disclosure information not submitted.
AC

Alejo Cucci, N/A

MD
HIGA San Martín de La Plata

Disclosure information not submitted.
MC

Matías Córdoba, N/A

MD
HIGA San Martín de La Plata

Disclosure information not submitted.
JF

Juan José Folco, N/A

MD
Hospital Gobernador Centeno, La Pampa

Disclosure information not submitted.
OB

Oswaldo Andrés Bolaños Ladínez, N/A

MD
Hospital Clínica San Francisco, Guayaquil (Ecuador)

Disclosure information not submitted.
PS

Pablo Saúl, N/A

MD
Hospital Francisco J. Muñiz

Disclosure information not submitted.
RL

Romina Belén Lumini, N/A

MD
Hospital El Carmen, Godoy Cruz (Mendoza)

Disclosure information not submitted.
PS

Pablo Staffolani, N/A

MD
Hospital Central de Mendoza

Disclosure information not submitted.
GV

Giovani Volpicelli, N/A

MD
San Luigi Gonzaga University Hospital (Italia)

Disclosure information not submitted.
FM

Fausto Vinico Maldonado Coronel, N/A

MD
Hospital General IESS Riobamba (Ecuador)

Disclosure information not submitted.
FT

Francisco Tomagnone, N/A

MD
Hospital Militar Central

Disclosure information not submitted.
MI

Martín Isa, N/A

MD
Clínica Regional del Sud, Río Cuarto

Disclosure information not submitted.
PS

Patrick Valentino Sepúlveda Barisich, N/A

MD
Hospital San Juan de Dios, La Serena (Chile)

Disclosure information not submitted.
DA

Débora Avila Poletti, N/A

MD
Hospital Italiano de Buenos Aires

Disclosure information not submitted.
MV

Mariana Vaena, N/A

MD
Hospital Italiano de Buenos Aires

Disclosure information not submitted.
FS

Fernando Ariel Sosa, n/a

MD
Hospital Alemán de Buenos Aires, Argentina

Disclosure information not submitted.

Introduction: Extubation fails in ~15–35% of ventilated ICU patients, and re-intubation worsens outcomes. Single-organ ultrasound studies exist, but integrated models are scarce. We hypothesized that a multiorgan ultrasound model would predict 48-hour extubation failure.

Methods: Prospective multicenter study in 15 hospitals across 4 countries (ClinicalTrials.gov NCT06609798) with local IRB approvals and surrogate consent. Outcome: extubation failure within 48 hours. Centers were split by hospital into derivation (74%; n=255) and external validation (26%; n=86). Predictors included modified Lung Ultrasound Score (LUS); TAPSE, MAPSE, E/e′; diaphragmatic excursion and thickening fraction; BMI; and prespecified interactions. We fitted mixed-effects logistic regression (random patient intercept) and a tuned random forest. For the logistic model, bootstrap validation (300 replicates) preceded external validation. Discrimination was summarized by c-statistic; calibration by Cox slope and calibration-in-the-large (CITL). Clinical benefit was expressed as observed failure proportions in predefined high- versus low-risk strata.

Results: We analyzed 341 extubations in 326 patients; 18.2% failed within 48 h. The final logistic model retained four interactions with explicit thresholds: TAPSE < 20 mm × diaphragmatic excursion < 14 mm (OR 2.38; 95% CI 1.21–4.69); MAPSE < 14 mm × E/e′ >15 (OR 3.59; 95% CI 0.82–15.77); LUS >6 × BMI (OR 1.01 per unit; 95% CI 0.99–1.04); MAPSE < 14 mm × BMI (OR 1.75; 95% CI 0.85–3.61). Bootstrap c-statistic was 0.65 (95% CI 0.56–0.74) with slope ≈1.02 and CITL -0.1; external c-statistic was 0.74 (0.59–0.90) with slope 1.05 (0.13–1.97) and CITL −0.51 (−1.17 to 0.14). With a 0.34 threshold (rule-in to defer extubation), 8.5% were high risk with 45% failures, versus 16% in low risk. The tuned random forest (30 trees; depth 1) achieved c-statistics of 0.70 (0.62–0.78) in derivation and 0.73 (0.59–0.88) in validation; at 0.24, 11.4% were high risk with 49% failures versus 14% in low risk.

Conclusions: A multiorgan ultrasound model predicted 48-hour extubation failure with good calibration and discrimination. Risk stratification concentrated failures in the high-risk group while keeping failure rates lower in the low-risk group, supporting ultrasound-guided, risk-based extubation decisions.