The literature supporting the use of NPPV in the acute-care setting for respiratory failure has evolved over the last 2 decades and is best summarized by disease process.5 Although there have been some exceptions, such as the 2010 meta-analysis by Burns and colleagues examining NPPV in acute respiratory failure of multiple causes,14 the use of NPPV has been most extensively studied in patients with acute respiratory failure due to COPD and congestive heart failure. In addition to these two well-studied uses, there is increasing interest in determining if NPPV can shorten the duration of invasive mechanical ventilation. The most extensive evidence currently concerns the use of NPPV to facilitate early extubation and also to prevent extubation failure in high-risk groups. There is less evidence regarding the use of NPPV in avoiding reintubation in patients whose extubation fails due to respiration distress. The preponderance of data regarding NPPV as a weaning tool, rescue strategy, and means of preventing reintubation is for patients with COPD or hypercapnia.