NPPV has been shown to significantly lower the risk of VAP and has also demonstrated a mortality benefit in randomized studies conducted using patients with a variety of illnesses10. A meta-analysis including 12 studies of over 800 patients, confirmed these findings11. Additionally, prior studies have shown that NPPV is particularly useful in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and patients with pulmonary oedema12,13. Therefore, it is recommended that NPPV be used when possible to prevent endotracheal intubation.