Biphasic cuirass ventilation (BCV) is a novel noninvasive negative pressure ventilation modality with under-investigated mechanisms. BCV supports spontaneous breathing and ventilation and has demonstrated potential benefit for pneumonia patients requiring prolonged noninvasive ventilation (NIV), including through integration with high-flow nasal oxygenation (HFNO). BCV represents an efficient noninvasive strategy for managing prolonged NIV. It facilitates both the intensification and reduction of ventilatory support during weaning. Late non-invasive ventilation (NIV) failure, a complex phenomenon potentially arising from muscular weakness, psychological factors, and mask interface intolerance, necessitates developing and implementing strategies and alternative ventilatory approaches to prolong NIV efficacy and maintain adequate gas exchange. Despite the significant potential of ventilatory alternatives to prolong noninvasive ventilation in this patient group, the clinical application of non-invasive negative pressure ventilation devices remains limited to a small number of specialized centers worldwide.