Aim and background: To analyze the demographic, clinical, and outcome characteristics of patients with acute respiratory failure (ARF) and to assess the impact of various factors on patient outcomes. Materials and methods: A total of 275 patients with ARF were included in this study. The mean age of patients was 48.18 ± 16.34 years, with a male predominance (64.0%). The distribution of respiratory failure types was as follows: 78.5% had type 1, 18.5% had both type 1 and type 2, and 2.9% had type 2 respiratory failure. Patients received different types of respiratory support: 50.5% with oxygen therapy (face mask, nasal cannula, etc.), 24.4% with noninvasive ventilation (NIV), and 25.1% required mechanical ventilation. Results: The most common etiology was pneumonia (18.5%), followed by heart failure (18.2%), poisoning (17.1%), sepsis (16.4%), and acute exacerbation of chronic obstructive pulmonary disease (COPD) (7.3%). Additional etiologies included acute pancreatitis, fluid overload, diabetic ketoacidosis, malignancies, and other less common conditions. The predominant symptom at presentation was breathlessness (58.2%), with fever (33.1%), cough (23.6%), and vomiting (23.3%) also frequently observed. The mortality rate was 77.1%, with 22.9% of patients being discharged. Significant associations were found between mortality and poisoning (χ² = 13.862, p < 0.001), altered sensorium (χ² = 4.054, p = 0.044), and vomiting (χ² = 5.117, p = 0.024). Fever was associated with a higher likelihood of discharge (χ² = 4.758, p = 0.029). There was no significant difference in outcomes based on the type of respiratory failure (χ² = 1.144, p = 0.564). However, the type of respiratory support significantly impacted outcomes, with mechanical ventilation being associated with higher mortality (χ² = 15.873, p < 0.001). Conclusion: Pneumonia was the most common cause of ARF, and breathlessness was the most common symptom. Mortality was high, with significant associations between certain presenting symptoms and outcomes. Respiratory support type significantly influenced patient outcomes, highlighting the critical role of tailored respiratory management in improving survival. Clinical significance: Early identification and tailored management of ARF, including careful selection of respiratory support and attention to high-risk symptoms, are crucial for improving outcomes.