6. Tracheal aspirate
Tracheal aspirates may be obtained via suction from an indwelling endotracheal tube in mechanically ventilated patients, or from direct tracheal suction of tracheotomized patients. The Chinese Society of Anesthesiology published their recommendations for tracheal intubation in critically ill COVID-19 patients, noting that this is an aerosol-producing procedure and should be avoided unless absolutely necessary.18 In the same regard, the collection of tracheal aspirates for viral detection poses a significant risk to the healthcare worker. Huang et al reported viral load comparisons in upper respiratory samples versus endotracheal aspirates in a cohort of 16 intubated COVID-19 patients and found that the latter has significantly higher viral RNA values compared to nasal and oropharyngeal swabs.19 However, this method of respiratory sampling is not relevant in ambulatory screening scenarios but may have a role in COVID-19 screening of patients on mechanical ventilation in intensive care units and for serial monitoring of viral load of intubated confirmed cases.