This change reduced the requirement for oxygen and normalized blood gases ( Table 2 ). The next day, the subcutaneous emphysema started to decline ( Figure 3 ). Peak inspiratory pressure was between 10 and 19 cm H 2 O with an FiO 2 of 50% for a SpO 2 of 90%. The child's level of distress was scored with the modified COMFORT scale [6] and it ranged between 11 and 14 (adequately sedated, as confirmed by the child). This clear improvement allowed us to reassign the child to the original hospital 48 hours after initiation of NAVA. NAVA was continued at the second facility, permitting extubation 3 days later.