Abstract
Background: Endotracheal intubation is a commonly performed lifesaving procedure in critically ill Intensive Care Unit (ICU) patients. Incorrect endotracheal tube placement may result in serious complications, including bronchial intubation, pneumothorax, atelectasis, and hypoxia. Chest X-ray (CXR) is considered the gold standard for confirming endotracheal tube position and detecting post-intubation pulmonary complications. Objectives: To assess and compare pre- and post-intubation chest X-ray findings, and to determine the frequency of correct and incorrect endotracheal tube (ETT) placement among intubated patients. Methodology: A descriptive cross-sectional study was conducted among 129 intubated ICU patients at Lady Reading Hospital and Hayatabad Medical Complex from December 2025 to April 2026. Patients with available pre- and post-intubation chest X-rays were included. Data on demographic characteristics, endotracheal tube placement, and radiographic findings were collected using a structured Questionnaire. Data were analyzed using IBM SPSS version 25.0, and a p-value of <0.05 was considered statistically significant. Results: A total of 129 intubated ICU patients were included in the study. Most patients were adults (89.9%), and males represented 53.5% of the sample. Consolidation was the most common pre-intubation chest X-ray finding (66.7%). Post-intubation chest X-rays demonstrated a significant increase in consolidation compared with pre-intubation findings (p < 0.001). Among patients with initially clear lungs, 48.8% developed new consolidation after intubation. New pneumothorax occurred in 2.4% of patients, while new atelectasis and pulmonary edema were observed in 5.6% and 5.6%, respectively. No significant changes were noted for pleural effusion, cardiomegaly, or ARDS severity. Conclusion: Post-intubation chest X-ray plays an essential role in confirming correct endotracheal tube placement and detecting pulmonary complications in ICU patients. The study demonstrated a significant increase in pulmonary consolidation after intubation, while pneumothorax, atelectasis, and pulmonary edema were observed in a smaller proportion of patients. These findings highlight the importance of routine post-intubation chest radiography for early identification of complications and improved patient management, particularly in resource-limited settings.