Objective: To determine levels of moral distress in a pediatric unit caring for patients with tracheostomy/ventilator dependence. Hypothesis: Moral distress will be significant in a dedicated pediatric trach/vent unit. Methods: The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to MD/DOs, advanced practice practitioners (APPs), RNs and RTs in a unit caring for tracheostomy/ventilator dependent patients. Descriptive statistics, bivariate and multivariate analysis were performed. Results: Response rate was 48% (61/127). Mean MDS-R score was 83 (range 43-119), which is comparable to reported levels in the pediatric intensive care unit. APPs had the highest median rate of moral distress (112, IQR 72-138), while MD/DOs had the lowest median score (49, IQR 43-77). RNs and RTs had MDS-R scores between these two groups (Medians of 91 and 84 respectively). Conclusions: Moral distress levels in a unit caring for long term tracheostomy and ventilator dependent patients are high, comparable to levels in pediatric ICUs. APPs had higher levels of distress compared to other groups. This may be attributable to the constant stressors of being the primary provider for complex patients, especially in a high-volume inpatient setting.