Understanding skin microclimate—the temperature and humidity at the interface between the skin and other surfaces—is critical for preventing pressure injury (PI). This prospective case series evaluated the performance of a hydrofibre multilayer foam dressing with silicone coating in managing the sacral microclimate in intensive care patients with intact skin at high PI risk when used with a standard PI prevention protocol. Sacral temperature and humidity were measured using a thermographic imaging camera and electrical bioimpedance device, respectively. These data were collected daily for a maximum of 7 consecutive days. Data of 25 patients were analysed. The mean sacral humidity during the first 4 days of dressing use was 20.7%. Its levels reduced on Days 5 and 6 and later returned to Day 2 levels on Day 7. The sacral temperature showed no sudden change with dressing use. Correlations between sacral microclimate and smoking, alcohol, systemic arterial hypertension, and diabetes mellitus were determined. There was no evidence of PI among the participants during the 7-day follow-up. The hydrofibre multilayered foam dressing with silicone coating effectively managed the sacral microclimate in high-risk intensive care patients, highlighting its potential utility in PI prevention protocols.