The authors report rapid, marked improvement in the blood gases of a 12-year-old girl with acute severe asthma and hypercapnia who breathed heliox (a unique therapy for acute asthma that decreases airway resistance without changing the diameter of the airway) during preparations for intubation.

Hypercapnia in a patient with acute asthma is an ominous prognostic sign. In the past, it was taught that eucapnia in patients with acute severe asthma merited readiness for endotracheal intubation because the eucapnia might indicate a patient in transition from hypocapnia to hypercapnia. Although intubation and mechanical ventilation can be lifesaving in patients with acute severe asthma, these interventions are associated with great risks.

Intubation of an air-hungry patient with acute severe asthma can be difficult and may require use of sedatives and neuromuscular blocking agents, drugs that may produce apnea. Patients in unstable...

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