Objective Exploring the impact of specialized critical care nursing combined with modified position management on the rehabilitation Effect of ICU patients with respiratory Failure. Methods A prospective controlled study design was adopted. A total of 122 patients with respiratory failure treated in the ICU of Zhongshan Hospital Affiliated to Xiamen University from February 2022 to January 2024 were selected and divided into a control group (60 cases) and an experimental group (62 cases) according to the admission time. The control group received routine ICU care, while the experimental group received specialized critical care nursing and modified position management in addition to routine ICU care. The ICU stay duration, hospital stay duration, mechanical ventilation duration, SCL-90 scores, MFI-20 scores, and incidence of complications were compared between the two groups. Results Compared with the control group, the ICU stay duration, hospital stay duration, and mechanical ventilation duration were significantly shorter in the experimental group (P ＜ 0.05). After intervention, the SCL-90 scores and MFI-20 dimension scores were significantly reduced (P ＜ 0.001). The total incidence of complications was significantly lower (5.00% vs. 16.13%, P=0.034). Conclusions Specialized critical care nursing combined with modified position management can effectively shorten the hospital stay and mechanical ventilation duration for ICU patients with respiratory failure, improve their mental state and fatigue symptoms, reduce the incidence of complications, and have a positive impact on patient recovery.