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Prophylactic noninvasive ventilation (NIV) reduces re-intubation in high-risk patients. However, its effects in elderly patients remain unclear. Here, we investigated the efficacy of prophylactic NIV in elderly patients after a planned extubation.From January 2011 to December 2017, patients aged ≥65years old were enrolled after completing an SBT. After extubation, patients who immediately received NIV were classified as the prophylactic NIV group, and those who did not were classified as the control group. Re-intubation was recorded at postextubation 72h.We enrolled 171 and 120 patients in the NIV and control groups, respectively. Patients in the NIV group had a lower re-intubation rate (6.4% vs. 23.3%, p<0.01) and lower hospital mortality (22.2% vs. 35.8%, p=0.01) than controls. In addition, prophylactic NIV was an independent protective factor for re-intubation (OR=0.15, 95% CI: 0.07–0.34, p<0.01 for all patients; OR=0.16, 95% CI: 0.05–0.52, p<0.01 for AECOPD patients, and OR=0.17, 95% CI: 0.05–0.62, p<0.01 for pneumonia/ARDS patients). After completing propensity-matched analyses, prophylactic NIV also reduced re-intubation and hospital mortality.Elderly patients received benefits from prophylactic NIV after a planned extubation.Extubation failure was high in the elderly.Prophylactic noninvasive ventilation after a planned extubation reduced extubation failure in the elderly.The benefits of prophylactic noninvasive ventilation were confirmed in the propensity-matched cohort.