Sedation minimization and early mobility to prevent intensive care unit delirium

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled trials, prospective cohort studies, and clinical guidelines published from 2017 through 2026, with inclusion based on relevance to delirium prevention. Studies consistently demonstrated that lighter sedation was associated with reduced delirium incidence compared with deep sedation, particularly in mechanically ventilated individuals. Pharmacologic choice also influenced delirium outcomes, with dexmedetomidine demonstrating more delirium-sparing effects than agents such as propofol. Early mobility interventions including physical therapy, occupational therapy, and progressive mobilization were associated with improved functional recovery and reduced delirium incidence. Structured bundles such as the ABCDEF framework, which integrate sedation minimization, early mobility, delirium monitoring, spontaneous awakening and breathing trials, and family engagement, demonstrated the most consistent benefits. These findings support evidence-based practices that improve outcomes, reduce complications, and enhance recovery. Future research should focus on implementation strategies and barriers to consistent adoption of these interventions across all ICU settings.