An observational study on the use of ultrasonography to confirm endotracheal intubation and the position of endotracheal tube in comparison to conventional methods in adult patients admitted under intensive care unit.

General physical examination, airway assessment and systemic examination will be conducted. Standard monitoring of hemodynamic parameters ( blood pressure, pulse rate, saturation, respiration rate) to be applied, patient will be assessed based on APACHE II scoring system.Assessment of patient’s GCS (glasgow come scale) . trained anaesthesiologist group or intensivist will perform all procedures to eliminate any possible complications.Under all aseptic condition, trained anaesthesiologist will proceed to intubate the patient. Upper airway ultrasonography will be performed during intubation, The linear probe (13-6 MHz) will placed transversely over trachea between suprasternal notch and cricothyroid membrane.absence of snow storm sign will be reported as tracheal intubation.oesophageal intubation will identified by appearance of double track sign. Endotracheal intubation will be confirmed with waveform capnography. Ultrasound of trachea will be performed again in sagittal plane to identify the cricoid cartilage and the tracheal rings. The ETT cuff will be fully deflated before being reinflated with 10cc of regular saline. The ETT cuff in the trachea will be recognized as an anechoic shadow. The cuff’s top end will be secured at the level of the third or fourth tracheal ring. Following the final tube installation, the ETT cuff’s saline will be aspirated, and the cuff will be reinflated with air to keep the intracuff pressure between 20 and 25 cm H2O.