In our PICU upon meeting the following criteria we initiate SBT based on current consensus: resolution of the basal cause of respiratory failure, peak inspiratory pressure (PIP) < 25 cm H 2 O, positive end-expiratory pressure (PEEP) < 5 cm H 2 O, tidal volume 6-8 ml/kg, FIo 2 < 0.40, intermittent and decreasing sedation, patient alert, hemoglobin > 10 g/dl, and decreasing vasoactives [2] [3] [4] .