Positive airway pressure ventilation systems are a therapeutic option in patients with confirmed SARS-CoV2 infection, who meet both clinical and biochemical criteria to be classified as moderate to severe cases, in order to avoid and / or delay progression to acute ventilatory failure.However, its success largely depends on a correct selection of the clinical setting.We present the case of a patient taken to non-invasive mechanical ventilation with slow positive end-expiratory pressure (PEEP) titration indicated in the event of persistent tachypnea despite correcting hypoxemia with conventional oxygen therapy, subsequently documenting a large mass in the anterior mediastinum, unknown to date.The patient had a favorable evolution from the clinical point of view.At the end, the eligibility criteria for considering the use of noninvasive mechanical ventilation in patients with COVID-19 will be discussed in a concise manner.