Background: The interplay between right ventricular dysfunction (RVD) and respiratory failure in septic shock is a critical determinant of outcome. Data on this interaction, particularly from resource-limited settings in sub-Saharan Africa, are scarce. This study aimed to determine the respiratory profile, management strategies, and prognosis of patients with septic shock and concomitant RVD. Methods: We conducted a single-center, prospective, observational cohort study in the intensive care unit (ICU) of Douala General Hospital, Cameroon, from December 2020 to August 2021. We included patients aged ≥21 years with septic shock. Data on demographics, clinical features, respiratory parameters (respiratory rate, SpO2, PaO2/FiO2), ventilator settings, and outcomes were collected. Patients were stratified by the presence of RVD. Results: Of 75 patients screened, 53 were included (mean age 53±16 years, sex ratio 1:1). Pulmonary involvement was present in 96.7% of patients with RVD. Acute Respiratory Distress Syndrome (ARDS) was diagnosed in 30.2% of the cohort. The mean respiratory rate was 29±22 breaths/min, and the mean PaO2/FiO2 ratio was 279±181. Invasive mechanical ventilation (IMV) was required in 50% of patients with RVD, and non-invasive ventilation (NIV) in 46.6%. Mortality for patients on IMV for over two days was catastrophically high at 92.9%. In contrast, the survival rate for patients managed with spontaneous breathing was 23.3% (p<0.005). The most common pathogens were Klebsiella pneumoniae (17.0%) and Staphylococcus aureus (15.0%). Conclusion: In patients with septic shock and RVD in our resource-limited setting, the development of respiratory failure is nearly universal and portends a dismal prognosis. The requirement for invasive mechanical ventilation is associated with extremely high mortality. These findings highlight the lethality of this clinical syndrome and underscore the urgent need for management strategies that protect the right ventricle and a