Luciano Gattinoni—A Fond and Grateful Remembrance

Every few generations, a brilliant mind, dedicated scientist, and cherished colleague emerges to illuminate our field and push the boundaries of its knowledge with unwavering commitment to discovery and deeper understanding. My close friend and colleague, Luciano Gattinoni, was one of these. Always positioned on the scientific edge, his ideas frequently outpaced the data available to support them; equally often, his incisive reinterpretation of existing data kindled valuable physiologic and clinical insights to better inform us all. Born in Milan in January 1945, Luciano completed his medical degree in 1969 and specialized in anesthesiology in 1974. At that time, life support in dedicated hospital units—what we now know as intensive care delivered in an ICU—was still in its earliest stage of development and was usually conducted as an extension of postoperative practices under the wing of that specialty. As was encouraged for many of Europe’s best, he undertook a sabbatical in the United States to advance his mastery of advanced clinical research. Between 1975 and 1977, “Lucio” worked closely with Antonio Pesenti and Roberto Fumagalli in the National Institutes of Health-Bethesda laboratory of Theodor Kolobow, where they helped originate the concept of resting the lungs after acute injury by developing methods of extracorporeal co2 removal for acute respiratory distress syndrome (ARDS). Notably, although overt barotrauma due to alveolar rupture was universally known to occur in ventilated patients, their recognition of the need for lung protection occurred well before general awareness of iatrogenic parenchymal injury (ventilator-induced lung injury [VILI]). Upon his return to Italy, Gattinoni became the Chief of Intensive Care of his home institution (Ospedale Maggiore Policlinico) at the University of Milan, a center already famous for excellence in thoracic imaging and physiology. He then forged connections over the next decade with other like-minded and physiology-oriented young leaders of our emerging field, such as Peter Suter, Konrad Falke, Adrian Versprille, Maurice Lamy, Jean-Louis Vincent, Goran Hedenstierna, Charis Roussos, and Francois Lemaire. Together they seeded the clinical, physiologic, educational, and administrative bases of our nascent intensive care discipline throughout Europe. Charismatic, self-confident and strong minded, Luciano proved a gifted leader in science, education, and professional organization. He would listen attentively to any logical argument of interest but remained unpersuaded by those that were not. Over his distinguished career, he authored more than 600 peer-reviewed articles and consulted for prominent national leaders—both foreign and domestic. In recognition of his seminal contributions, Luciano received numerous accolades, earning honorary memberships in prestigious international societies, and Lifetime Achievement Awards from both European and American institutions. Professor Gattinoni, always highly respected by his peers, served—very effectively if rather reluctantly—as President of the European Society of Intensive Care Medicine and of the World Federation of Intensive and Critical Care. If paradigm shifting can be thought of as “breaking new ground,” Luciano was always “shovel ready.” But to him, the evidence from population-based randomized controlled trials (RCTs), whose rationale and statistical methodology was so quickly (and to his mind uncritically) adopted by our field, seemed unfocused and produced predictable results too easily explained. He did, however, recognize the potential value of RCTs as a final test of a rational hypothesis or as the stimulus for formulating a new one, and when well-purposed and carefully designed, participated actively in such exercises. Yet, given the imprecise clinical definitions of ARDS and sepsis and the lack of a strong physiologic underpinning for most RCTs, the “what” or “how” answers their outcomes provided never seemed enough to advance personalized bedside practice. Curiosity was his watchword, and for him, the “why” is what counted. Marching to his own rhythm and always challenging the status quo, Lucio discounted what he considered baseless opposition to his applied physiology and, in the process, made foundational contributions to improve care and safety at the bedside of patients with acute lung injury. Among many other influential works, he introduced the novel concept and implications of the (small, not stiff) “baby lung” of ARDS, defined the underlying mechanisms of prone positioning, and helped perfect extracorporeal gas exchange. His elegant physiologic studies of VILI and mechanical power of ventilation, as well as his innovative use of quantitative CT scanning provided pivotal steps forward toward implementing safer ventilatory support. As an educator, Professor Gattinoni had few equals. His presentations filled auditoriums, where the audience listened to the master with rapt attention, knowing that they would emerge with intriguing ideas and new viewpoints to consider. Although not always verified, his adventuresome and deep thinking as well as commitment to unraveling causative mechanisms frequently led in new and fruitful directions. Now in its 36th year, the ‘SMART’ symposium that he conceived and initiated with his closest Milanese colleagues has become the largest annual gathering of Italian intensivists and continues as one of the premier educational conferences in Europe. Interpersonally, Luciano tended to pull out all the stops, often sharing laughter and intense conversations in restaurants with close friends over a bottle (or two) of good wine. This man had an artistic soul to complement his extraordinary scientific mind. A superbly skilled pianist, he wrote and arranged music, performed frequently in public concerts, and recorded spirituals and folk songs with his quartet of 60 years, Mnogaja Leta. Seven marketed CD recordings and a full-length biography chronicle their long and successful association. At invited dinners at his home, Luciano’s piano accompaniment to singing by his guests typically highlighted the evening. Apart from his musical endeavors, Luciano avidly read both classical and contemporary literature and cheered for his preferred soccer club, AC Milan. Luciano traveled the world as invited faculty and was embraced enthusiastically wherever he went. He became a mentor to many, always willing to guide with genuine warmth, encouragement, and collaborative spirit those in whom he perceived innate ability and serious scientific interest. This was never more in evidence than when he “retired” from his administrative obligations in Milan. Moving then to Germany as a guest professor under the sponsorship of Michael Quintel at the University Hospital of Gottingen, he mastered that initially unfamiliar language, established local collaborations, and attracted a team of gifted junior investigators drawn from diverse Italian universities—the “Colonia Italiana.” Their productive research, lasting cohesion as a group, and devotion to him stand as a tribute to his engagement and leadership. Luciano’s innate curiosity, excitement in discovery, and testing of new ideas never flagged in his later years. Despite important health challenges, his last decade was among the most satisfying and happy of his life. Successful emulation of his career path by later generations may never be easy, but a life like his—full of passion, curiosity, intellectual honesty, and accomplishment must be remembered, admired, and celebrated.Figure 1.: Luciano Gattinoni.