Enhancing ICU Safety & Multisystem Monitoring

How Realize-365 integrates high-velocity ICU data to detect early shock escalation and prevent adverse events in critically ill patients.

Rapid Detection

Identifies hemodynamic instability early

Data Integration

Correlates vitals, labs, and output

Patient Safety

Prevents refractory shock progression

Clinical Background

Patient: Sofia Morales, 36y (Diagnosis: Septic shock secondary to necrotizing pneumonia)

Setting: Medical ICU (intubated, mechanically ventilated). PMH: Asthma, obesity (BMI 31), prior ICU admission for ARDS. Reason for ICU Stay: Refractory hypoxemia, vasopressor support, ongoing antibiotic therapy.

Hemodynamic Deterioration & Early Shock Escalation Detection

Clinical Problem

At 03:00, Ms. Morales’ MAP decreases despite norepinephrine at 0.16 mcg/kg/min. Nurses document lower urine output and rising lactate in separate flowsheets. Early septic shock escalation is easily missed during night staffing.

Realize-365 Action

Query: "Extract the last 6 hours of hemodynamics, urine output, lactate, and vasopressor requirements. Determine whether this patient is entering refractory shock."

MAP: 68 → 58 mmHgBelow goal despite pressors

Norepinephrine: 0.10 → 0.16 mcg/kg/minRising requirement

Urine Output: 35 → 15 mL/hrWorsening perfusion

Lactate: 3.2 → 4.1 mmol/LTissue hypoperfusion

Insight: Findings consistent with worsening septic shock and evolving vasopressor resistance. Meets criteria for refractory shock. Recommendation: add vasopressin, initiate corticosteroids, obtain ABG, re-evaluate source control.

Impact

Identifies shock escalation hours earlier.
Prevents cardiac arrest / multi-organ failure.

Ventilator Weaning Readiness Assessments

Clinical Problem

Ms. Morales is on Day 5 of mechanical ventilation. The intensivist must evaluate readiness for an SBT (spontaneous breathing trial). But readiness indicators are documented in five separate systems.

Realize-365 Action

Query: "Pull all ventilator parameters, ABG results, sedation scores, and secretion/cough documentation from the last 12 hours. Does the patient meet SBT criteria?"

FiO2 / PEEP40% / 5 cmH2O (Stable)

ABGpH 7.39, PaCO2 41 (Acceptable)

RASS Score-1 to 0 (Adequate wakefulness)

Insight: Patient meets standardized SBT readiness criteria. Recommend initiating SBT with close RT monitoring. If tolerated ≥30 minutes, consider early extubation.

Impact

Saves 5–10 minutes per ventilator patient per round.
Reduces delays in weaning and ICU LOS.

Multi-Drug Interaction Monitoring in a Complex ICU Regimen

Clinical Problem

Ms. Morales is receiving multiple high-alert medications. The ICU team suspects QT prolongation risk, sedation-drug interactions, and renal dosing concerns, but verifying this across MAR, labs, and telemetry is time-consuming.

Realize-365 Action

Query: "Analyze all active ICU medications, telemetry QTc values, and renal labs. Identify any safety risks or interactions requiring adjustment."

QT ProlongationAzithromycin + QTc 482 ms (Moderate-High Risk)

Renal FunctionCr 1.6 mg/dL, rising (Vancomycin adj needed)

Glucose Variability220–260 mg/dL (Intensify insulin)

Insight: QT prolongation risk elevated with azithromycin; consider switching antibiotic. Rising creatinine requires vancomycin trough and dose adjustment.

Impact

Prevents ICU medication complications (QT prolongation, AKI).
Replaces a complex, 10-minute manual review.

Why this case matters

Pattern Recognition

Realize-365 identifies the "perfect storm" of falling output, rising lactate, and hemodynamic drift that characterizes early shock.

Night Shift Safety

Acts as an always-on safety net, especially critical during night shifts when staffing ratios may be lower and fatigue higher.

Proactive Care

Shifts ICU care from reactive "rescue" events to proactive hemodynamic management.