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Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after \u201cnegative\u201d trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha\u20102 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long\u2010term outcomes including cognitive impairment.<\/jats:p>","DOI":"10.1002\/phar.2807","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T11:02:03Z","timestamp":1683111723000},"page":"1139-1153","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["<scp>Precision\u2010based<\/scp> approaches to delirium in critical illness: A narrative review"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0990-997X","authenticated-orcid":false,"given":"Melissa J.","family":"Ankravs","sequence":"first","affiliation":[{"name":"Pharmacy Department and Intensive Care Unit Royal Melbourne Hospital  Parkville Victoria Australia"},{"name":"Department of 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