Heat Preconditioning Protects Skin Pressure Injury and Reduces Incidence of Intraoperatively Acquired Pressure Ulcers in Both Humans and Animals

Abstract To examine the preventive effect of heat preconditioning (HPC) on intraoperatively acquired pressure ulcers (IAPU) in surgical patients and explore the mechanisms of HPC on pressure injury (PI) in rat skin. We generated a skin PI model using hairless rats and treated these rats with HPC. Skin injury size was measured and the expression of heat shock proteins (HSPs) in the skin were examined by real-time RT PCR, Western blotting, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into HPC and control groups. We measured sacral skin temperature, sacral pressure and compared the PI prevalence rate. HPC treatment significantly reduced both area(p =0.007, p =0.007, p =0.012) and incidence (p=0.025, p =0.019, p =0.012) of PI in rats on the second, third and fourth days. HSP27 expression was increased in HPC group. Immunohistochemical staining showed that HSP27 was distributed in all types of dermal cells with increase in basal cells. In human studies, HPC treatment increased sacral temperature (p<0.001). The incidence of IAPUs was significantly decreased by 75% in HPC group. HPC can reduce the incidence of PI in both experimental animals and humans. Beneficial effects of HPC were possibly mediated by upregulation of HSP27.