Heart failure is an increasingly prevalent disease in the United States and most developed countries, despite significant improvements in treatment options. Approximately one million patients in the United States are admitted every year due to acute pulmonary edema secondary to cardiac causes. First-line management most commonly includes the use of loop diuretics and oxygen supplementation. However, when the respiratory failure due to pulmonary edema is not fully compensated with these methods, it requires greater oxygen and respiratory support. The way of providing these higher requirements is by providing positive pressure ventilation (PPV). There are two methods for PPV: non-invasive positive pressure ventilation (NIPPV) versus invasive ventilation, which is known as endotracheal intubation (EI). In this chapter, we will highlight the benefit of using NIPPV, and more specifically bi-level positive airway pressure (BiPAP) in the management of a patient with cardiogenic pulmonary edema (Heidenreich et al. Circulation 145:e876–e894, 2022; McDonagh et al. Eur J Heart Fail 24:4–131, 2022).