OBJECTIVE Acute respiratory failure is a common complication of the severely burn-injured patient. Endotracheal intubation and mechanical ventilation is associated with a high rate of complications. Noninvasive Positive Pressure Ventilation (NIPPV) has been shown to be as effective as conventional ventilation in improving gas exchange and is associated with fewer complications with patients in acute hypercapnic and hypoxaemic respiratory failure. We report our experience with NIPPV in 30 burn patients. METHODS The records of all burn patients from 1998 to 2000, where NIPPV was used as part of their management at the St. Andrew's Centre for Plastic Surgery and Burns, were reviewed. RESULTS Mean age was 47.56 years (range 12-81). Nine patients were female. Mean burn size was 24.4% total body surface area (TBSA) (range 3-54). Inhalation injury was confirmed in eight cases. A positive diagnosis of pneumonia was made in 29 patients. The mean PaO(2)/FiO(2) ratio prior to institution of NIPPV was 28.98Kpa (range 8.75-52). Intermittent Positive Pressure Breathing (IPPB) was the most common ventilatory mode employed (25 patients) and the face mask was the most used interface (18 cases). Twenty-two patients (74%) avoided endotracheal intubation and their respiratory function continued to improve after NIPPV was discontinued. One patient (3%) died and seven patients (23%) were reintubated. Three out of the seven were electively reintubated for burns surgery. CONCLUSIONS In burn-injured patients with acute respiratory failure, NIPPV appears to be effective in supporting respiratory function such that endotracheal intubation can be avoided in most cases.