Delirium is a common yet under-recognized complication in mechanically ventilated ICU patients, contributing to prolonged ventilation, restraint use, sleep disruption, and increased risk of mortality. This case involves a 51-year-old man with acute respiratory failure who developed CAM-ICU–positive delirium characterized by agitation and sleep–wake reversal. The nursing team implemented the ABCDEF ICU Liberation Bundle to mitigat risks.The ABCDEF bundle consists of: A: Assess, Prevent, and Manage Pain: CPOT-guided analgesia (scores 3–4 → 0–1). B: Both SATs and SBTs: daily readiness testing for sedation interruption and ventilator weaning. C: Choice of Sedation: avoidance of benzodiazepines; titration to RASS −1 to 0 to maintain light, cooperative sedation. D: Delirium Assessment, Prevention, and Management: twice-daily CAM-ICU, reorientation, nighttime noise reduction, sleep promotion, and minimized psychoactive agents. E: Early Mobility: progression from passive ROM to active limb exercises and bed-edge sitting, supporting oxygenation and muscle preservation. F: Family Engagement and Empowerment: structured involvement to enhance emotional stability, orientation, and communication. Daily outcomes included CAM-ICU, RASS, CPOT, restraint duration, sleep continuity, mobility progression, oxygenation stability, and emotional responsiveness.This case demonstrates the full implementation of all six bundle components, illustrating how nursing-led coordination can operationalize physiologic, cognitive, environmental, and psychosocial interventions to achieve measurable improvements in a real ICU setting.Delirium improved rapidly (CAM-ICU Days 1–3 → negative by Day 5). Restraints decreased from bilateral to a single soft restraint by Day 10 and were removed post-extubation. Sleep consolidated from 3–4 nightly interruptions to 7–8 hours. Mobility progression stabilized oxygenation, preserved muscle strength, and supported extubation on Day 15. Family involvement enhanced emotional stability and communication. Future priorities include nighttime care protocols, structured family engagement, and digital checklists to strengthen adherence.Clinical outcomes aligned with evidence showing that multimodal delirium strategies shorten delirium duration, stabilize sedation, strengthen mobility, and increase patient participation in care.The ABCDEF bundle effectively reduced delirium duration, minimized the use of restraints, restored sleep rhythms, and supported earlier cognitive and functional recovery. Nursing leadership was essential in coordinating interventions and sustaining ICU Liberation practices. Keywords: Delirium, Intensive Care Unit, Patient Care Bundles