Ecological flow, defined as the water flow regime necessary to sustain ecosystem health, is a critical factor in global water resource management. However, human activities and the lack of institutional and community involvement have significantly impacted its stability. This study conducts a systematic review of 126 articles from the SciELO and Scopus databases, categorizing them based on thematic similarities, with a focus on ecological flow impacts, aquatic biota, and strategies for improvement. The research methodology utilizes the Parsifal tool, enabling hypothesis development and leading to three key findings: (1) identification of the primary indicators influencing ecological flow and aquatic biota, (2) comparative analysis of vulnerability levels among different water bodies, and (3) recognition of the deficit in the integrated application of sustainable conservation mechanisms. The results highlight those variations in alteration parameters, affected water bodies, and the effectiveness of sustainable strategies depend on the specific environmental conditions of each study area. Aligned with Sustainable Development Goal (SDG) 13: Climate Action, the study underscores the importance of ecological flow management not only for aquatic ecosystem conservation but also for climate change mitigation and adaptation. The protection and restoration of water bodies should be prioritized as fundamental strategies to counteract climate change effects, integrating environmental conservation with community well-being. These findings emphasize the urgent need for policies and actions that align with global sustainability objectives, particularly in the context of climate resilience.