In this article, we present a set of lightweight mechanisms to enhance the dependability of a safety-critical real-time distributed system referred to as an integrated clinical environment (ICE). In an ICE, medical devices are interconnected and work together with the help of a supervisory computer system to enhance patient safety during clinical operations. Inevitably, there are strong dependability requirements on the ICE. We introduce a set of mechanisms that essentially make the supervisor component a trusted computing base, which can withstand common hardware failures and malicious attacks. The mechanisms rely on the replication of the supervisor component and employ only one input-exchange phase into the critical path of the operation of the ICE. Our analysis shows that the runtime latency overhead is much lower than that of traditional approaches.