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

In the case of marked inspiratory stridor following extubation in a pediatric patient, the situation suggests potential upper airway obstruction or significant swelling of the airway. The immediate concern in such a scenario is the airway's patency and the patient's ability to breathe effectively.

Re-intubation is often considered the best immediate action when stridor is severe and there is a risk of respiratory compromise. This action ensures that the airway is secured, thus preventing complete obstruction and allowing for adequate ventilation. It is a critical measure in emergency situations where other interventions may not be rapidly effective enough to ensure the patient’s safety.

Other options may provide relief but are often less definitive in a critical scenario where stridor is present due to possible swelling. While cool mist aerosol and heliox therapy can be beneficial in managing mild to moderate upper airway edema, they don’t guarantee immediate airway protection or resolution of severe stridor. Administering racemic epinephrine may help reduce swelling in the airway, but it is generally considered a temporizing measure and may not suffice in life-threatening situations. Therefore, re-intubating the patient is the most appropriate immediate intervention when confronted with marked stridor following extubation.