Aims & Objectives: This study aimed to identify risk factors for non-invasive respiratory support (NRS) failure and compare complications between patients receiving invasive mechanical ventilation (IMV) only and NRS failure. Methods: A cohort study was conducted using data from the LARed Network registry, covering the period from April 2017 to November 2022. The study included children under 18 years old admitted to the pediatric intensive care unit (PICU) for acute respiratory failure (ARF). Patients were categorized into three groups: IMV-only, NRS failure with subsequent IMV, and NRS success. Risk factors were analyzed using multivariate mixed models, and complications were compared between the IMV-only and NRS failure groups. Results: Out of 7,374 eligible children, 6,208 were in the NRS group and 1,166 in the IMV-only group. The success rate for NRS was 85%. Younger age, prematurity or malnutrition history, suspected bacterial infection, elevated measures (inspired oxygen, heart and respiratory rate), and lung opacities on chest X-ray were associated with a higher risk of NRS failure. Conversely, wheezing or lung hyperinflation were associated with a lower frequency of NRS failure. No significant differences were found in morbidity, mortality, duration of IMV, or length of PICU stay between the IMV-only and NRS failure groups. However, patients with NRS failure had a higher likelihood of withdrawal and/or delirium. Conclusions: This study identified risk factors for NRS failure in pediatric patients. Overall outcomes at PICU discharge were comparable between the IMV-only and NRS failure groups, except for a higher incidence of withdrawal and/or delirium in the latter. Keywords: non-invasive ventilation, Oxygen Therapy, Latin America, Continuous Positive Airway Pressure, pediatric intensive care unit