Nasal intermittent positive pressure ventilation (NIPPV) represents a major advance in the management of respiratory failure. While its role in chronic respiratory failure is well documented, its use in acute respiratory failure is less well defined. We studied four patients with respiratory failure due to kyphoscoliosis, two of whom presented with acute respiratory acidosis. All four patients were on conventional maximum medical therapy prior to treatment with NIPPV. All patients survived to be discharged from hospital on home ventilation and significant improvements were noted in pO2, pCO2 and pulmonary function. We conclude that NIPPV is useful in the management of both acute and chronic ventilatory failure due to kyphoscoliosis.