TRANSPORT, WEANILEVO, CLEANSE — and the intraoperative hypotension meta-analysis

Three critical-care trials, plus the BJA intraoperative hypotension meta-analysis written up in full after the PDF was supplied.

Imported from the original Cowork run log. Days before 2026-08-20 were recorded as titles and links only, so those entries are shorter than the ones written since.

1. TRANSPORT — liberal vs restrictive transfusion in cancer patients with septic shock

Journal · Published: Intensive Care Medicine, online 19 August 2026 Pène et al.

Stopped early. No difference in 12 h lactate clearance (52% vs 50%) or mortality (46% vs 53%), but thrombotic events were higher with the liberal strategy — 13% vs 1%, P=0.001.

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2. WEANILEVO — levosimendan for VA-ECMO weaning

Journal · Published: Anesthesiology 2026;145(3):676–688 (surfaced on CCR journal-watch 14 August 2026) Guinot et al.

Double-blind multicentre RCT. Results paywalled — sent as design plus literature context only.

Interpretation. Follows LEVOECMO, which was negative.

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3. CLEANSE — HA-330 haemoadsorption in high-catecholamine septic shock

Journal · Published: Critical Care 2026;30:426, 11 June 2026 — older, sent as an actively-debated item, not as new Wongtirawit et al.

28-day mortality 44% vs 58% (HR 0.68, 95% CI 0.44–1.07, P=0.09); post-hoc adjusted P=0.037. Now under formal critique (Ramírez-Guerrero et al., Crit Care 2026;30:390).

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4. Intraoperative hypotension and adverse postoperative outcomes

Journal · Published: British Journal of Anaesthesia, Article in Press, accepted 29 May 2026 Sicova, Alkadri, Sibley et al.; senior author van Klei

Initially flagged as paywalled on 2026-08-20, then written up in full once the PDF was supplied. PROSPERO CRD420251230069.

9 RCTs (14,658 patients) for the primary outcome, 13 RCTs for secondary outcomes.

All-cause 30-day mortality: RR 1.06 (95% CI 0.77–1.45, P=0.73), I²=0%. Trial sequential analysis did not cross monitoring boundaries even for a 20% RRR — underpowered, not a confirmed null.
AKI: RR 1.00 (0.92–1.09). Myocardial injury: RR 1.03 (0.94–1.12). Both crossed TSA boundaries for a 20% RRR — more conclusively null.
Meta-regression: the achieved MAP difference between arms did not modify any outcome.

Key caveat. The achieved MAP separation between “higher” and “lower” arms was modest, often <10 mmHg, and control arms rarely fell below the 60–65 mmHg observational danger threshold. Most trials therefore didn’t actually test the causal question.

Interpretation. Updates and extends the D’Amico & Fominskiy 2023 BJA meta-analysis (n=4 trials) by adding 5 newer RCTs including IMPROVE-multi (Saugel, JAMA 2025), PRE-TREAT (Kant, JAMA 2025) and BP-CARES (Zhao, JACC 2025).

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Considered but not sent

Nakashima et al. — Ultra-early vs early adjunctive vasopressin in septic shock (target trial emulation) — Intensive Care Med, 14 Aug 2026. Secondary scope, available for a future run. DOI 10.1007/s00134-026-08575-3