Cross-over Comparison of the V60 System to Other Bi-Level Noninvasive Ventilators

Inclusion Criteria: * Age \> 7 years and \< 18 years * Weight \> 20 kg (44 lbs) * Respiratory failure or respiratory insufficiency * Ability to cooperate with the investigators * Designated adult able to provide Informed Consent Exclusion Criteria: * An endotracheal tube or tracheostomy in place * Hemodynamically instability * Prolonged apnea * Inability to maintain the airway * A recent history of cardiac and or respiratory arrest * Acute hemorrhage * Multiple organ system failure * Undrained pneumothorax * High risk for aspiration * Metastatic or terminal cancer * Do-not-resuscitate orders * Inability to clear respiratory secretions * Inability to fit a mask * Facial surgery, trauma, or deformity * Upper gastrointestinal or airway surgery * Pregnancy * Refractory delirium * PaO2 \< 50 mmHg on present settings * Designee unable or unwilling to provide Informed Consent