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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Mechanical ventilation (MV) associated complications lead to prolonged ICU length of stay (LOS), increase healthcare costs, and poor patient outcomes. Research has consistently exhibited the importance of timely extubation. However, research has not demonstrated robust data on extubation readiness strategies. An adult study reported decreased extubation failures, mortality, and LOS in patients extubated at night. Thus an examination of temporally-related pediatric extubation failure may help standardize timing and improve outcomes. The purpose of this study is to examine nighttime vs. daytime extubation failure. Methods: Our retrospective study at a tertiary, academic hospital included 343 PICU patients with at least 1 planned extubation from 2013–2015. Patients that expired, were tracheostomized, transferred, or had insufficient data were excluded. Demographics, ventilation variables, and LOS were evaluated via chi-square and fisher exact testing. Daytime was defined as 07:00-18:59 and nighttime was defined as 19:00-06:59. Extubation failure was defined as re-intubation within 24–72 hours. Results: Daytime extubations (263) yielded 15 (5.7%) failures compared to 5 failures (6.2%) with 80 nighttime extubation attempts. There was no statistically significant difference in temporallyrelated extubation failure (p-value = 0.85). However, weight (p-value = 0.007), age (p-value = 0.011), and length of MV (p-value = 0.000) were associated with increased incidence of nighttime extubation failure. Conclusions: Contrary to data reported in adults, pediatric extubations at night did not have a significant decrease in extubation failure when compared to those during the day. However, it seems demographics such as weight, age and length of MV do impart risk of extubation failure irrespective of the time of day in which the extubation is attempted. The ability to properly identify cues for extubation readiness in young children and those with prolonged MV is more important that the time of day of an extubation attempt.