Subjects in Group 2 will be kept on the NIPPV machine for 4 hours minimum, unless the PED or PICU treating attending deems the patient has dramatically improved to take off the machine. The study investigator will collect information regarding medications given and any complications. At the end of the 8 hour study period, a PAS score will be calculated, and the study investigator will ask the PED or PICU treating attending whether to continue present therapy or switch to another therapy.