Introduction: Pneumomediastinum produced by barotrauma is a possible complication from the mechanical ventilation, since the positive pressure produces alveolar rupture. The incidence is variable, and increases according to the indication of mechanical ventilation (1). In a prospective study with 5183 ICU patients, the overall incidence was 2.9%, reaching 6.5% in patients with acute respiratory distress syndrome (ARDS)(2). The incidence is higher in invasive ventilation than in non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP). Barotrauma risk can be diminished with protective measures, such as using low support pressure and reduced tidal volumes (1,3).During the health crisis caused by the COVID-19 coronavirus pandemic, a high percentage of the severe patients (up to 15.6% in a review of 1099 patients in Wuhan, China) had respiratory distress (7). In the context of respiratory failure the first step is conventional oxygen therapy. Secondly, if it’s available, the High-flow Nasal Cannulas (HFNC). And finally invasive or non invasive ventilation (NIV). This last one should not postpone intubation (8).We present the case of a patient with COVID19 positive who, after starting an NIV, suffered a pneumomediastinum and subcutaneous emphysema.