Children with severe asthma exacerbations necessitating admission to a pediatric intensive care unit (PICU), also known as acute asthma (CA), are given several treatments, including heliox. For a study, the researchers sought to update estimates of heliox prescription and look for connections between heliox and mechanical ventilation frequency and duration using the Virtual Pediatric Systems database. From 2013 to 2019, researchers conducted a retrospective cohort research using data from 97 PICUs involving children aged 3 to 17 years who were admitted for CA. Heliox prescribing rates and trends were the primary outcome. Mechanical ventilation rates and duration were studied in subgroups based on heliox exposure. Heliox was administered to 1,070 (2.5%) of the 43,238 individuals investigated. The average rate of heliox prescriptions has decreased from 4.11% in 2013 to 2.37% in 2019. Heliox use was higher in the South (2.6%) and Midwest (3.3%) than in the West (1.6%) and Northeast (1.6%, respectively, P<.001). Mechanical ventilation rates were 273/39,739 (0.7%) in the subgroup measuring mechanical ventilation frequency and higher for those given heliox (1.9% vs 0.7%, P<.001). There were no differences in median mechanical ventilation time between those with and without heliox (4.94 [interquartile range [IQR] 3.04–6.36] vs 4.63 [IQR 3.11–7.30]d; P=.35) in the subgroup examining mechanical ventilation duration. Noninvasive heliox was not linked to mechanical ventilation in exploratory adjusted models. Mortality was uncommon (206/43,238 [0.47%]) and mostly occurred in patients who had been intubated before admission (188/206 [91.3%]). Heliox was a rare (2.5%) supplementary therapy for children with CA, and it was not related to mechanical ventilation or shortened mechanical ventilation duration in adjusted models. The updated estimations in the paper would help researchers build prospective controlled trials to understand the role of heliox in CA better.