Non-invasive ventilation (NIV) is not recommended for patients with PIAH1N1 virus infection complicated by pneumonia, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) because although NIV temporarily improves oxygenation and reduces the work of breathing in these patients, it does not necessarily change the natural disease course. On the other hand, NIV may increase the risk of respiratory pathogen transmission [2] and there is not enough evidence to support the treatment of ALI/ARDS with NIV. To date, three studies have suggested that NIV has not been successful in critically ill patients with hypoxemic respiratory failure attributable to PIAH1N1 virus infection [1, 3, 4] . In these studies a total of 76 patients received NIV, but 64 (84.2%) of these patients required subsequent intubation and invasive ventilation.