Noninvasive positive pressure ventilation (NIPPV), which can be applied without endotracheal airway or tracheostomy, has been used as the first-line device for patients with acute decompensated heart failure (ADHF) and cardiogenic pulmonary edema. Positive airway pressure (PAP) devices include continuous PAP, bilevel PAP, and adaptive servoventilation. NIPPV can provide favorable physiologic benefits, including improving oxygenation, respiratory mechanics, and pulmonary and systemic hemodynamics. It can also reduce the intubation rate and improve clinical symptoms, resulting in good quality of life and mortality.