After extubation, a specialist notices marked inspiratory stridor in a 5-year-old patient. What should be the immediate action?

Marked inspiratory stridor following extubation in a patient, especially a pediatric one, suggests the presence of significant upper airway obstruction or swelling. In such cases, the immediate priority is to secure the airway. Re-intubation is often necessary when there are signs of severe respiratory distress or stridor that indicates significant airway compromise.

This decision is based on the need to ensure adequate ventilation and prevent precarious situations that might arise from upper airway obstruction. Administering racemic epinephrine could provide temporary relief for laryngeal edema, but it does not address the underlying issue if the stridor is severe enough to necessitate emergent airway intervention.

Similarly, while cool mist aerosol and heliox therapy might also help in certain scenarios, they are not immediate interventions to address a critical airway situation. Thus, re-intubation is often considered the safest and most effective course of action when marked stridor is present following extubation.