A retrospective record study was conducted on all kids aged at least 3 months who were admitted to a pediatric ICU at a children’s hospital with acute respiratory failure needing noninvasive ventilation (NIV) between 2015 and 2018. The participants were divided into 2 groups: those who received continuous dexmedetomidine and those who did not. Medical history and basic demographic information were assessed for developmental delay (DD) or intellectual disability (ID). The use of enhanced inverse probability weighting to produce similar baselines between the dexmedetomidine and no-sedation groups was used to regulate the connection between these variables and both dexmedetomidine use and intubation. The primary outcome was intubation rate within 6 hours of starting dexmedetomidine infusion or NIV. Because of the vital link between age and dexmedetomidine use, a statistical model that included patients over the age of 5 could not be created. These subjects were omitted from the final analysis. The final statistical analysis included 138 individuals, 60 of whom were given dexmedetomidine and 48 given no sedation. Dexmedetomidine successfully reduced agitation, with no change in intubation rate between dexmedetomidine and no sedation at 6 hours (13.1 vs 12.4%). Dexmedetomidine might have improved NIV tolerance without increasing the risk of intubation in patients with acute respiratory failure, particularly those under the age of 6 and those with DD or ID. A broader investigation including numerous locations would have been beneficial in bolstering the outcomes.