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 Background: Communication with patients who are unable to express themselves verbally due to sedation or invasive mechanical ventilation represents a fundamental yet challenging aspect of intensive care nursing practice. In the absence of spoken language, intensive care nurses must interpret patients’ needs, preferences, and emotions through bodily cues and physiological indicators. This process is essential for promoting a sense of security, participation and dignity. Aim: To describe intensive care nurses’ experiences of communicating with patients who are unable to communicate verbally as a result of sedation or invasive mechanical ventilation. Method: An integrative literature review based on 20 scientific articles retrieved from PubMed and CINAHL Plus. The material was analysed in accordance with Whittemore and Knafl’s model for integrative analysis. Results: Three themes were identified: challenges in communication, strategies used to facilitate communication, and organisational factors. Non-verbal communication, communication aids, and collegial support emerged as important resources, while limited time and high workload were identified as significant barriers. Conclusion: Communication with patients who are unable to express themselves verbally constitutes a complex yet essential component of intensive care nurses’ practice. Increased educational opportunities and stronger organisational support may enhance the conditions for providing good nursing care.