Objective To explore the effect of optimized respiratory tract nursing intervention on patients with large area of severe burns in ICU. Methods A total of 100 patients with large area of severe burns admitted to our hospital from January 2021 to December 2022 were randomly divided into control group and observation group, with 50 patients in each group. The control group was given routine nursing, and the observation group was given optimized respiratory tract nursing. The nursing effect, hospitalization time, nursing satisfaction, burn repair related indicators and complication rate were compared between the two groups. Results The total effective rate of nursing in the observation group was higher than that in the control group (P<0.05). The clinical indexes of the observation group were better than those of the control group (P<0.05). The satisfaction of the observation group was higher than that of the control group (P<0.05). The indexes of burn repair in the observation group were better than those in the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion The implementation of optimized respiratory tract nursing intervention can reduce hospitalization time and cost, reduce the probability of tube blockage and infection, improve patient satisfaction, and improve the success rate of burn repair.