Congestive heart failure (CHF) is a common cause of respiratory failure for which patients seek emergency care. Mechanical ventilation is commonly used in the treatment for severe CHF. Studies have shown that noninvasive ventilation (NIV) methods, such as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP), are effective in treating CHF and have fewer complications than endotracheal intubation. The use of NIV in the treatment of CHF has been shown to increase oxygenation, improve hemodynamic stability, and decrease the need for intubation. When NIV is chosen for a patient in CHF, the critical care nurse needs to be vigilant in assessing and monitoring these patients, especially those in severe CHF. This article evaluates the differences between the 2 types of NIV, the controversies that may exist, practice issues for the critical care nurse, and any financial considerations.