Non-invasive positive pressure ventilation (NIPPV) (e.g. bi-level positive airway pressure) is indicated for the treatment of both acute hypercapneic and hypoxemic respiratory failure. In individuals with COPD, respiratory muscle fatigue with increased airway resistance or decreased compliance often leads to respiratory distress and failure. Bi-level positive airway pressure via nasal oral, oronasal, full and total face mask provides alternating levels of inspiratory pressure to keep the airway open as an individual breathes in, and expiratory pressure to reduce the work of exhalation. NIPPV is associated with lower rates of death and endotracheal intubation in individuals with acute respiratory failure compared with usual practice, with the greatest benefit in individuals with an AECOPD [85]. Invasive ventilation is used for hypercapneic failure in those individuals who do not tolerate or benefit from NIPPV or cannot sustain NIPPV effort.