The study evaluated the effects of AIDET communication combined with alternating prone ventilation in awake elderly patients with severe pneumonia. Eighty-six patients were assigned to the AIDET group or the conventional group. At 72 hours, the AIDET group had a higher comfort score (8.3 ± 0.9 vs. 6.5 ± 1.1; p < 0.001) and better oxygenation (PaO2/FiO2: 289.4 ± 2.63.5; p < 0.001). Inflammatory markers decreased more in the AIDET group: HIF-1α by 24.3% (p < 0.001), sTREM-1 by 22.7% (p = 0.003) and hs-CRP by 28.1% (p < 0.001). The success of weaning from ventilation was higher (95.3% vs. 76.7%; p = 0.013) with a shorter time (median 47 h vs. 62 h; p < 0.001). These results support the incorporation of structured communication into respiratory care.