Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsEDC designed the study, recruited patients, performed data analysis, and drafted the manuscript. CAH, MEM, and EMM were involved in study design and drafting the manuscript. LAM recruited patients maybe and helped draft the manuscript. IPD Study Group recruited patients. DLB, GJ, PB, SN, and HP performed laboratory analysis and helped draft the manuscript. SW provided statistical advice and helped with data analysis. RSH helped draft the manuscript.NotesSee related commentary by David et al., http://ccforum.com/content/14/4/180AcknowledgementsThe IPD (Invasive Pneumococcal Disease) Study Group (Nurses: C Antonio, M Chinamale, L Jere, D Mnapo, V Munthali, F Nyalo, J Simwinga; Clinical Officer: M Kaole; Field Workers: A Manyika, and K Phiri).

We thank the children included in this study and their parents and guardians for giving consent for them to participate in the study. We also extend thanks to the nursing and medical staff at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), Research Ward, for their contribution to this study.EDC was supported by a Wellcome Trust Career Development Grant (grant no. 068026). The Malawi-Liverpool-Wellcome Trust Clinical Research Programme is supported by the Wellcome Trust.CAH died suddenly in September 2007, but in view of his significant contribution to the study, it was agreed that he should be included as a co-author.Presented in part as an oral presentation, 13th Spring Meeting of the Royal College of Paediatrics and Child Health, April 2009, UK.

Arch Dis Child 2009; 94(suppl 1): A20
In the ICU, acute respiratory failure is a common problem that usually requires endotracheal intubation [1]. Airway management in critically ill patients, from intubation to extubation, remains a high-risk procedure [2,3]. Endotracheal intubation is a well-known cause of marked changes in respiratory mechanics and gas exchange [4,5]. When intubation is used to treat respiratory failure, underlying patient pathology can increase such modifications and the reduction in lung volume results in deep hypoxemia after intubation. Moreover, mechanical ventilation applied to a collapsed and/or infected lung increases the risk of ventilator-induced lung injury [6,7].Baillard and colleagues have recently shown that preoxygenation with non-invasive ventilation (NIV) is more effective at reducing arterial oxyhemoglobin desaturation after intubation than the usual method [8]. The increase in oxygenation in the NIV group was still significant 30 minutes after intubation. Dacomitinib The authors emphasized that alveolar recruitment was seen during preoxygenation with NIV.