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Reintubation after failed extubation is associated with high mortality. Noninvasive ventilation (NIV) has been used to prevent reintubation, but the results have been inconclusive. We investigated the factors predicting failure of NIV-assisted extubation among medical critically ill patients.This retrospective cohort study enrolled patients who were admitted to medical intensive care units at Siriraj Hospital between March 2012 and August 2015 who required more than 48 hours of mechanical ventilation and who received NIV after endotracheal extubation. NIV was considered to have failed if the patient required reintubation during intensive care unit admission.A total of 105 patients (57 male; mean age, 63.3 ± 17.9 years) were enrolled. The reintubation rate was 45.7%. Univariate analysis identified pre-NIV Sepsis-related Organ Failure Assessment score >3.5, respiratory failure caused by pneumonia, heart rate after NIV for 1 hour of more 100 beats per minute, fluid accumulation greater than 100 mL/kg, and NIV duration more than 96 hours as factors associated with reintubation. However, multivariate analysis identified pneumonia as the only predictive factor for failure of NIV-assisted extubation among critically ill patients. Reintubated patients had significantly higher hospital mortality than successfully extubated patients.Respiratory failure caused by pneumonia is predictive of failure of NIV-assisted extubation.