Introduction: Drowning is still a relevant medical challenge and a leading cause of accidental death worldwide. Hypoxia is the starting point for all morbidity and mortality and it must remain the focus of treatment.

Case Report: We report the case of non-fatal drowning in an epileptic patient who presented to the emergency department with acute respiratory failure (ARF) and subsequent neurological status impairment. The patient’s condition was managed with early non-invasive ventilation (NIV). He was rapidly discharged from ICU despite severe hypoxemia on admission. Although the applications of NIV have been increased recently in the emergency settings, reports about its efficiency in drowning ARF are limited.

Conclusion: Early administration of non-invasive ventilation would be interesting to manage drowning induced ARF through positive expiratory pressure while avoiding complications related to conventional ventilation.

Keywords: Acute respiratory distress syndrome, Acute respiratory failure, Drowning, Non-invasive ventilation