Trial of Spontaneous Breathing Test

Inclusion Criteria: * Patients admitted to the PICU on MV for more than 24 hours * Patients over 1 month old (corrected gestational age \> 38 weeks) and \< 18 years old on the day of screening for ERT Exclusion Criteria: * Perinatal-related lung disease * Congenital diaphragmatic hernia or congenital/acquired paralysis of the diaphragm * Children with heart disease * Primary pulmonary hypertension * Bronchiolitis obliterans * Post-hematopoietic stem cell transplant; specifically, patients receiving continuous supplemental oxygen for three or more days prior to intubation; receiving noninvasive ventilation for more than 24 hours prior to intubation; receiving more than one vasoactive medication at the time of meeting the inclusion criteria; spending more than four days in the PICU prior to intubation; supported by or with immediate plans for renal replacement therapy; with two or more allogeneic transplants; who relapsed after transplant; or with diffuse alveolar hemorrhage * Post-lung transplantation * Home ventilator dependence with baseline Oxygen Saturation Index (OSI) \>6 (baseline is defined as a stable period prior to the present illness) * Neuromuscular respiratory failure * Critical airway obstruction (e.g., post-laryngotracheal surgery or new tracheostomy) or anatomical lower airway obstruction (e.g., mediastinal mass) * Facial surgery or trauma in the past two weeks * Intracranial bleeding * Morbid obesity (2w-24mo: WHO weight-for-length z-score/height z-score ≥+3; ≥2y: WHO body mass index (BMI)-for-age z-score ≥+3) * Family/medical team unsupportive total (patient treatment considered futile) * Previously enrolled in a current study * Enrolled in any other clinical trial with intervention not approved for concomitant enrollment * Pregnancy