Objective To evaluate the clinical efficacy and safety of fiberoptic bronchoscopy-guided bronchoalveolar lavage in the treatment of respiratory failure. Methods A total of 90 patients with respiratory failure admitted to Zhengzhou Central Hospital from October 2023 to August 2025 were enrolled and divided into control group (n＝44) or an intervention group (n＝46) according to treatment strategy. The control group received standardized conventional therapy, while the intervention group additionally underwent fiberoptic bronchoscopy-guided bronchoalveolar lavage. Oxygenation (arterial partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2)), inflammatory markers (C-reactive protein (CRP), procalcitonin (PCT)), clinical outcomes, and adverse events were compared between the two groups. Results After treatment, oxygenation and inflammatory markers improved in both groups, with significantly greater improvements in PaO2, PaO2/FiO2, CRP, and PCT levels in the intervention group compared with the control group (all P＜0.05). The intervention group also showed shorter duration of mechanical ventilation and hospital stay (all P＜0.05), as well as a higher overall treatment effectiveness rate (P＜0.05). There was no significant difference in the incidence of adverse events between the two groups (P＞0.05). Conclusion Fiberoptic bronchoscopy-guided bronchoalveolar lavage, when used as an adjunct to conventional therapy, can effectively improve oxygenation, reduce inflammatory responses, and optimize short-term clinical outcomes in patients with respiratory failure, with an acceptable safety profile.