 Despite the frequent use of mechanical ventilation, determining when to appropriately discontinue mechanical ventilation and extubate a patient remains a challenge. Many weaning protocols exist but are typically extrapolated from adult studies. These protocols can consist of but are not limited to use sprint weaning utilizing a T-piece no support, just oxygen, continuous positive airway pressure CPAP or pressure support PSV trail. Usually, data is gathered through spirometry with a ventilator shallow breathing index, tidal volumes, etc. and vital signs are recorded 7, 8. Despite the use of protocols extubation failure range from 15-24 Randolph in the pediatric population. 