Positive pressure ventilation improves left ventricular stroke volume through the predominant effect on afterload reduction in euvolemic or hypervolemic patients.

NIV reduces the need for intubation and the mortality rate in patients with acute chronic cardiac exacerbations compared with standard therapy.

No difference in myocardial infarction risk has been shown between patients treated with CPAP/BiPAP versus standard oxygen therapy.

No significant differences have been shown when studying CPAP versus BiPAP in terms of hospital mortality or need for intubation. There were no significant differences between the two ventilatory techniques in terms of hospital length of stay or risk of myocardial infarction.

CPAP is recommended, in addition to SMT, in patients with severe respiratory failure due to cardiogenic pulmonary edema (class IIa recommendation, level of evidence A). CPAP must be considered the first-line intervention in patients with ACPE because it is easier to use than BiPAP and no differences have been shown between them when the two techniques were compared.

The best location for NIV use depends on the hospital conditions, the indication or lack thereof for orotracheal intubation, and the multidisciplinary team that includes nurses, doctors, and physiotherapists.