Severe acute pulmonary edema is a medical emergency that requires immediate action on the part of the health care provider. Endotracheal intubation and mechanical ventilation remain the primary method of respiratory support in the most severe cases when respiratory failure ensues. Two cases of respiratory failure resulting from severe acute pulmonary edema are presented in which mechanical ventilation was indicated but the patients were treated instead with noninvasive bilevel positive pressure ventilation, which subsequently reversed their inspiratory failure. The use of noninvasive bilevel positive pressure ventilation in the emergency treatment of respiratory failure secondary to severe acute pulmonary edema is discussed.