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.