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However, there is little focus on the peri\u2010operative pathophysiology of recovery in this patient group, as done to develop enhanced recovery pathways in elective care. Acute inflammation is the main driver of the perioperative pathophysiology leading to adverse outcomes. Pre\u2010operative high\u2010dose of glucocorticoids provides a reduction in the inflammatory response after surgery, effective pain relief in several major surgical procedures, as well as reduce fatigue and improving endothelial dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the effect of high\u2010dose glucocorticoid on the inflammatory response, fluid distribution and recovery after acute high\u2010risk abdominal surgery in patients with IO and PV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>AHA STEROID trial is a sponsor\u2010initiated single\u2010center, randomized, double\u2010blind placebo\u2010controlled trial, assessing preoperative high\u2010dose dexamethasone (1\u00a0mg\/kg) versus placebo (normal saline) in patients undergoing emergency high\u2010risk abdominal surgery. We plan to enroll 120 patients. Primary outcome is the reduction in C\u2010reactive protein on postoperative day 1 as a marker of successful attenuation of the acute stress response. Secondary outcomes include perioperative changes in endothelial and other inflammatory markers, fluid distribution, pulmonary function, pain, fatigue, and mobilization. The statistical plan is outlined in the protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The AHA STEROID trial will provide important evidence to guide the potential use of high\u2010dose glucocorticoids in emergency high\u2010risk abdominal surgery, with respect to different pathophysiologies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14040","type":"journal-article","created":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T16:04:05Z","timestamp":1644163445000},"page":"640-650","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["AHA STEROID trial, dexamethasone in acute high\u2010risk abdominal surgery, the protocol for a randomized controlled trial"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8970-639X","authenticated-orcid":false,"given":"Mirjana","family":"Cihoric","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Hvidovre Hospital  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2209-1711","authenticated-orcid":false,"given":"Henrik","family":"Kehlet","sequence":"additional","affiliation":[{"name":"Section for Surgical Pathophysiology  Rigshospitalet Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten Laks\u00e1foss","family":"Lauritsen","sequence":"additional","affiliation":[{"name":"Gastrounit, Surgical Section Hvidovre Hospital  Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"H\u00f8jlund","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Hvidovre Hospital  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrine","family":"Kanstrup","sequence":"additional","affiliation":[{"name":"Gastrounit, Surgical Section Hvidovre Hospital  Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolai Bang","family":"Foss","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Hvidovre Hospital  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,2,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardiores.2006.11.021"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0803563"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13721"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12492"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc4928"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12620"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14514"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14902"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10427"},{"key":"e_1_2_9_11_1","unstructured":"NELA study The fourth patient Report of the National Emergency Laparotomy audit Full patient report."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967\u2010015\u20100481\u20105"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801601"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.06.031"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000895"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003746"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14406"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000286984.39328.96"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2018.1475177"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1072\u20107515(02)01491\u20106"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31822a24c2"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182261118"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010158\u20103\u2010201302050\u201000583"},{"key":"e_1_2_9_24_1","doi-asserted-by":"crossref","unstructured":"World Medical Association Declaration of Helsinki.JAMA.2013;310(20):2191. doi:10.1001\/jama.2013.281053","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_2_9_25_1","unstructured":"The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Hyman Use (ICH) Expert Working Group.Integrated addendum to ICH E6(R1): Guideline for Good Clinical Practice E6(R2). 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