Biphasic cuirass ventilation (BCV) has become more readily available and portable, allowing ease for administration of negative pressure ventilation (NPV). NPV augments a patient’s natural respiration, allowing for recruitment of areas of atelectasis, dilation of pulmonary capillaries, and improvement in preload to the heart with augmentation of cardiac output. Consequently, NPV offers a hemodynamic profile superior to positive pressure ventilation. This form of noninvasive ventilation can be used alone or in conjunction with other noninvasive modalities for respiratory support. In pediatrics, BCV is used in diseases such as bronchiolitis, pneumonia, and asthma. The advantages of using BCV include the preservation of physiological functions (e.g., speech, cough, swallow) while allowing for ease of suctioning. In the neonatal population, there is a potential role for the use of NPV in respiratory distress of the newborn and neonates with congenital diaphragmatic hernia. BCV can be used in shorter durations each day, or overnight while sleeping, in the outpatient setting to help support those with neuromuscular diseases or other chronic respiratory conditions. The physiologic changes that occur with the increase in negative intrathoracic pressure are particularly beneficial in patients with right-sided cardiovascular pathologies. NPV is frequently used after repair of right-sided heart lesions, as it has been shown to improve cardiac output, stroke volume, and pulmonary and systemic vascular resistances. The most common side effects include poor compliance, musculoskeletal pain, hypothermia, skin irritation at contact points, and upper-airway obstruction. Monitoring with frequent assessments to evaluate the integrity of the skin, temperature, and tolerance of the device is recommended. Special consideration is advised in patients with musculoskeletal abnormalities of the thorax or severe obesity. Lastly, the use of NPV is not recommended in patients with a lack of upper airway protection, upper airway obstruction, open skin lesions, trauma, or recent surgery to the thorax/abdomen.