Noninvasive ventilation (NIV) has been associated with a reduction in reintubation rate compared with standard oxygen in several types of acute respiratory failure (ARF) of variable causes: decompensation of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and following abdominal surgery. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing procedural complications and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. All major NIV complications are potentially life-threatening and can occur in any patient but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. In AHF syndromes, NIV should be used in patients with acute cardiogenic pulmonary edema (ACPE). It may be considered in other acute heart failure (AHF) patients with right failure (RF) associated with lung disease and in some cases of cardiogenic shock (CS), after stabilizing the blood pressure. To optimize patient outcome, NIV should be applied by an experienced team, with careful patient selection according to available guidelines and good clinical judgment, taking constantly into account the risk factors for NIV failure. Once begun, patients should be closely monitored in an Intensive Care Unit (ICU) or step-down unit until adequately stabilized, paying attention not only to vital signs and gas exchange but also to tolerance, comfort, air leaks, and patient–ventilator interaction. The proper choice of device, adequate management of ventilatory support, a skilled team, and accurate clinical and instrumental monitoring are crucial to minimize the risk of complications. It is necessary a careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start to reduce NIV complications.