The non-invasive positive pressure ventilation (NIPPV) refers to the application of artificial ventilation without any conduit access to the airways, i.e. without an endotracheal or tracheostomy tube. Recently, NIPPV has assumed a prominent role in the management of acute respiratory failure. By avoiding endotracheal intubation, NIPPV prevents complications associated with invasive ventilation like airway problems, nosocomial pneumonia and sinusitis. The NIPPV, when used, decreases the work of breathing and rests the respiratory musculature. It improves alveolar ventilation and gas exchange. Its role has proved effective in acute exacerbation of COPD, weaning failure and cardiogenic pulmonary edema, chronic ventilatory failure, cystic fibrosis. Some contradictions for the use of NIPPV are hemodynamic instability, life threatening hypoxemia, copious secretions, severe GI symptoms, non-availability of trained medical personnel. The success of NIPPV depends on selecting the right patient. This process should take into account the diagnosis, clinical status of the patient, risk of failure and clinical judgment of the caregiver. Due to its success now days it is now considered as standard first-line therapy in several conditions.