endotracheal intubation in order to ensure airway patency and minimize risks of procedure-related respiratory insufficiency. [4][5][6][7] In many instances, however, bronchoscopy can be safely performed while the patient receives NPPV, sparing patients the discomfort and risks of refractory hypoxemia, intubation, and mechanical ventilation. The limited available published evidence indicates that NPPVassisted flexible bronchoscopy is used about 3 times per month in tertiary academic centers. 4,7 Critical care nurses have an essential role in the preparation and performance of this procedure, as well as in surveillance after the procedure, and, as part of the multidisciplinary health care team, in patient care decisions. The objectives of this article, therefore, are to review the physiological basis for NPPV-assisted bronchoscopy; describe its indications, contraindications, and techniques; and identify ways in which critical care nurses can further influence patient care before, during, and after this airway procedure. Critically ill patients with the aforementioned comorbid conditions may require diagnostic or therapeutic flexible bronchoscopy to diagnose or treat causes of airway obstruction, atelectasis, and pneumonia. Standard practice in these instances is to recommend bronchoscopy with high-flow supplemental oxygenation via face mask, or to proceed with sedation and N oninvasive positive pressure ventilation (NPPV) is defined as any form of ventilatory support applied without endotracheal intubation. 1An often-used alternative to endotracheal intubation, NPPV reduces the need for invasive mechanical ventilation in patients with hypoxic respiratory failure due to cardiogenic pulmonary edema or immunocompromised state. NPPV is also used to improve postoperative hypoxemia; reduce pulmonary complications after cardiac, upper abdominal, Noninvasive positive pressure ventilation is an alternative to intubation in critically ill patients with respiratory insufficiency or poor gas exchange who may require flexible bronchoscopy for diagnostic or therapeutic purposes. This ventilatory technique might help decrease the risk of bronchoscopy-related complications in patients with refractory hypoxemia, postoperative respiratory distress, severe emphysema, obstructive sleep apnea, and obesity hypoventilation syndrome and allows bronchoscopic assessment of patients with severe dyspnea from expiratory central airway collapse. In this review, the physiological rationale, indications, contraindications, techniques, and monitoring requirements for flexible bronchoscopy assisted by noninvasive positive pressure ventilation are described, with an emphasis on the role of critical care nurses in this procedure. (Critical Care Nurse.