Objective To explore the application effect of the feedforward control risk model combined with the bundled care in elderly patients with severe pneumonia undergoing mechanical ventilation. Methods This study adopted a retrospective cohort study design and was grouped in chronological order. The clinical data of 43 elderly patients with severe pneumonia who received conventional bundled care plan and underwent mechanical ventilation in Guangzhou Chest Hospital from December 2022 to June 2024 were collected as the control group. The clinical data of 43 elderly patients with severe pneumonia who received the feedforward control risk model combined with bundled care plan and underwent mechanical ventilation in Guangzhou Chest Hospital from July 2024 to December 2025 were collected as the study group. The rehabilitation indicators (mechanical ventilation time, total hospital stay, blood count recovery time), respiratory and oxygenation indicators (partial pressure of oxygen (PaO2), oxygenation index (OI), arterial partial pressure of carbon dioxide (PaCO2)), psychological state (Connor-Davidson resilience scale (CD-RISC)) and quality of life (World Health Organization quality of life-brief (WHOQOL-BREF)), and the occurrence of complications were compared between the two groups. Results The mechanical ventilation time and total hospital stay in the study group were significantly shorter than those in the control group (all P＜ 0.05), blood count recovery time was significantly earlier than that of the control group (P＜0.05). After the nursing intervention, the respiratory rate and PaCO2 in the study group were significantly lower than those in the control group (all P＜0.05), and the PaO2, OI and the scores of the CD-RISC and the WHOQOL-BREF were significantly higher than those in the control group (all P＜0.05). The complication rate in the study group was significantly lower than that in the control group (P＜0.05). Conclusion The application of the feedforward control risk model combined with bundled care in elderly patients with severe pneumonia undergoing mechanical ventilation can promote the patient’s disease recovery, improve pulmonary breathing and oxygenation functions, enhance psychological resilience and quality of life, and reduce the occurrence of complications.