Background Maintaining patent airway with tracheal intubation is frequently indicated at ICUs. Many tools can help to assure that the endotracheal tube (ETT) is properly placed, but each one of these tools has its limitations and cannot be applied in every patient. Aim of this study The aim of the study was to assess the role of tracheal ultrasonography in confirming ETT placement in ICU patients. Patients and methods This study included 200 patients (120 men and 80 women with a mean age of 49.1 ±12.4) with an indication of intubation at the respiratory ICU at Zagazig University Hospitals from January 2016 to March 2018. Ultrasonography of the trachea and capnography were done in addition to clinical assessment to confirm correct placement of ETT with taking capnography as the gold standard method for detecting the place of ETT. Sensitivity and specificity of ultrasonography against capnography in confirming proper endotracheal intubation were calculated. Results Of the 200 patients studied, 177 patients had confirmed ETT in the trachea by both capnography and tracheal ultrasonography; seven patients had confirmed ETT in the trachea by capnography only, and 16 patients had ETT outside the trachea by both capnography and tracheal ultrasonography. The sensitivity and specificity tracheal ultrasound were 96.2 and 100%, respectively. The time (s) needed to confirm the ETT position by clinical assessment, tracheal ultrasonography, and capnography was 19.21, 15.13, and 12.89, respectively, with highly significant statistical difference between them (P<0.001). Conclusion Tracheal ultrasound can be a rapid and safe tool to confirm correct endotracheal tube placement.