Tele-ICU platform model: point of care equipment telemetry and real-time remote critical assistance

To describe the requirements for modeling the tele-ICU platform, its development, the process, software, and hardware technologies employed. We also present its performance based on a proof-of-concept in a remote intensive care unit environment.

This multicenter, prospective implementation study was conducted in three Level III Intensive Care Units in distinct Brazilian regions between June 2021 and December 2022. The INTEGRARE®, an Internet of Medical Things-based hardware/software architecture enabling agnostic integration of multiparameter monitors and mechanical ventilators, was deployed to provide continuous high-frequency telemetry, a unified analytical dashboard, and synchronous audiovisual communication for tele-round sessions. The proof-of-concept comprised continuous multimodal monitoring, collaborative tele-round discussions, and structured knowledge transfer. Nineteen months of multiparameter monitors and mechanical ventilators data were processed through a four-step data workflow (edge server, cloud storage, preprocessing, and analytical layer). All clinical, operational, and performance metrics were automatically generated by the platform.

The INTEGRARE® enabled integration of multiparameter monitors and mechanical ventilator devices across 30 intensive care unit beds, generating over 2 billion data points with a median acquisition frequency of ~1 second and cross-device synchronization under 5 seconds. A total of 361 patients were monitored (7,235 intensive care unit-days), with a median intensive care unit stay of 14 days and 11 days on mechanical ventilators among ventilated patients. Tele-round sessions completed 484 hours, with a median of 3 hours and 39 minutes per intensive care unit per week. The platform supported real-time visualization and retrospective review of physiological curves, ventilator mechanics, laboratory results, and imaging within a unified dashboard. High adherence to tele-round routines was observed across multidisciplinary teams, who spontaneously incorporated multimodal telemetry into case discussions. Immediate bedside impact was common, including rapid identification and correction of patients' ventilator asynchrony.

The Tele-UTI Conectada model provides a technical infrastructure that supports standardization, situation awareness, and collaborative clinical decision-making by integrating real-time telemetry with synchronous audiovisual interaction across heterogeneous intensive care units. Multidisciplinary teams successfully adopted the platform and routinely used it to conduct structured case discussions.