Despite widespread use of noninvasive ventilation (NIV) in some coronavirus disease 2019 (COVID-19) hypoxemic patients, its clinical application is still subject of debate. This is a retrospective, observational study with data collected from 91 consecutive patients treated in COVID intensive care unit (ICU) in our institution between October 2020 and February 2021. Outcomes were represented as ventilation hours, ICU and hospital length of stay, and ICU and hospital mortality. Patients' mean age was 66 ± 11 y and severe COVID-19 pneumonia with mean paO /FiO 137 ± 57 was observed in 90% of the patients. High positive end-expiratory pressure (PEEP) NIV by means of total face mask was initially applied in 58 (64%) patients, high flow oxygen therapy (HFOT) in 25 (27%) patients, whilst invasive mechanical ventilation (IMV) started at the moment of admission in 8 (9%) patients. NIV and high flow oxygen therapy (HFOT) have been kept on throughout ICU stay in 50 (55%) patients, while 41 (45%) patients were put on IMV. Overall ICU mortality was 41%, while ICU mortality of patients on NIV was 14%. High PEEP NIV was convenient and safe as initial respiratory support and in some COVID-19 ARDS patients remained an optimal respiratory support throughout their disease.