The immunocompromised patients complicated with acute hypoxemic respiratory failure (AHRF) who require invasive mechanical ventilation have higher mortality. Early initiation of noninvasive positive pressure ventilation (NPPV) has been shown to improve oxygenation and reduce the incidence of endotracheal intubation. A recent European multi-centered randomised controlled trial (RCT) in 374 immunocompromised critically ill patients reported no significant difference in intubation rate or mortality between NPPV group and the control group (HFNC), although the clinical efficacy of NPPV are affected by patient selection and many other factors. However, early application of NPPV still has important clinical value. NPPV has been applied during bronchoscopic examination and helps in early extubation, thus playing an important role on diagnosis and shortening duration of invasive ventilation. We still recommend NPPV as a first line therapy in such above patients.