The combined use of thermography and ultrasound to evaluate the development of pressure injury in a critically ill patient

Introduction: Pressure injury is 1 of the most common pressure related injuries in patients admitted to the intensive care unit. In individuals with darker skin tones, skin assessment protocols appear to be less effective, resulting in early damage from pressure. Bedside assessment measures using ultrasound and infrared thermography (IRT) have been studied to identify pressure injuries. Patient concerns: A 58-year-old dark-skinned male was admitted to the intensive care unit due to an ischemic stroke. Diagnosis: The visual evaluation of the skin took place on the second day after admission to the intensive care unit (before 48 hours). The patient had a whitish erythema on the left heel (LH) and a large bloody blister on the right heel. There were no signs of color change on the sacrum skin. Interventions: We performed 3 skin evaluations of the sacrum and calcaneus using ultrasound and IRT. Outcomes: Changes in the temperature of the target regions (sacrum, right heel and LH) were observed. The right heel showed higher mean temperatures than the LH in all evaluations. In the first evaluation of the sacrum region, the average temperature was lower (-1.3°C) than in the second and third evaluation (1°C). In the calcaneus, the mean temperature range (right heel - LH) showed a difference of (3.5°C) in the first evaluation, a difference of (1.4°C) in the second evaluation, and a difference of (1.7°C) in the third evaluation. Ultrasound images of the selected regions showed abnormal tissue patterns - edema - since the first evaluation. Conclusion: These findings indicate that the regions with deep tissue injury on ultrasound evaluation were compatible with the regions of abnormal temperatures in the IRT. IRT could identify regions of pathological process, which could be confirmed by abnormal ultrasound findings. Well-designed, randomized research with a larger sample could verify if the combination of these assessment techniques could be used as a potential method for early detection and evaluation of pressure injuries.