Objective To evaluate the effect of noninvasive positive pressure ventilation (NPPV) treatment on the reintubation rate and mortality in patients with acute respiratory failure after extubation. Methods Randomized controlled trials of NPPV on respiratory support and therapy of patients with acute respiratory failure after extubation since 2000 were referred in NCBI PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang database. Stata 12.0 software was used for data analysis. The odds ratio (O^R) and corresponding 95% confidence interval (95% CI) were used to assess the reintubation rate and death rate of NPPV adjuvant treatment and conventional therapy. Results According to the inclusion and exclusion criteria, a total of 9 clinical randomized controlled trials were conducted with 996 patients, of whom 518 were in the NPPV treatment group and 478 were in the conventional treatment group. The reintubation rate of NPPV treatment group and conventional treatment group was respectively 7.7% (40/518) and 23.0% (110/478), the difference was statistically significant (P < 0.05); the mortality rate was respectively 6.8% (35/518) and 17.4 (83/478), the difference was statistically significant (P < 0.05). Compared with conventional treatment, NPPV treatment significantly reduced the risk of reintubation and mortality after extubation [ O^R = 0.260 and 0.340, (95% CI: 0.180, 0.390) and (95% CI: 0.220, 0.510)]. Conclusion NPPV treatment after extubation help to reduce the risk of reintubation and mortality in patients with acute respiratory failure.