The study evaluated the safety and efficacy of early bedside bronchoscopy-assisted sputum aspiration in patients with stroke and pneumonia. A retrospective analysis included data from patients admitted to the Department of Respiratory Medicine and Critical Care Medicine at the General Hospital of Northern Theater Command from January 1, 2022, to December 3, 2022. The bronchoscopic aspiration group had a significantly shorter ICU stay than the control group (3,364 ± 4,574 days vs. 6,199 ± 11.38 days; p = 0.03). The duration of antibiotic treatment was shorter in the intervention group (9.792 ± 7.17 days versus 12.51 ± 10.38 days; p = 0.0414). The proportion of patients with clinical improvement was higher in the bronchoscopy group, but the difference was not statistically significant. There were no significant differences between the groups in the occurrence of complications such as hypoxia, hemoptysis or arrhythmia. The application of bedside fiberoptic bronchoscopy shortens the stay in the ICU and the use of antibiotics and has clinical value.