Luciano Gattinoni: a tribute to a pioneer in intensive care medicine

Abstract

Luciano Gattinoni was a truly exceptional scientist and a unique personality. He was one of the rare individuals destined to be cited in medical textbooks for generations to come. He passed away at the end of an extraordinary, active, and impactful life, just shy of his 80th birthday.

Gattinoni studied in Milan, where he completed high school with a focus on classical humanities. This background profoundly shaped his thinking, leaving an indelible mark on his life and work. After graduating from medical school and fulfilling compulsory military service as a medical officer in the Alpine troops—a role he often recounted with characteristic humor—Gattinoni became captivated by a nascent discipline: Intensive Care Medicine.

At the time, intensive care medicine was virtually unknown in Italy. Gattinoni joined a group of intelligent, resourceful young physicians determined to establish this emerging specialty at the Ospedale Maggiore Ca’ Granda in Milan. Founded on April 1, 1456, this historic hospital housed the city’s medical school and fostered an inspiring environment of youthful energy and innovation. Under the farsighted direction of Professor Giorgio Damia, the ICU team developed a unique, friendly team spirit that persists to this day, even as many of its members have retired or passed away.

Luciano quickly stood out with his charm, quick wit, and insatiable curiosity—a trait that defined him throughout his life. Driven by an unrelenting desire to understand the mechanisms of disease, he and his colleagues placed physiology at the heart of their clinical reasoning, guided by a shared mantra: “Measure, measure, measure”.

To support himself during his early career, Gattinoni moonlighted in a clinical chemistry lab, performing blood tests and cell counts. There, he met Luigi Rossi Bernardi, a renowned biochemist whose research had brought him into contact with Dr. Theodor “Ted” Kolobow at the NIH. Kolobow, the inventor of the spiral coil membrane lung—the first such device commercialized for human use—was an extraordinary scientist and innovator passionate about artificial organs and respiratory pathophysiology. A WWII refugee from Estonia, Kolobow’s ethical trait was legendary; he famously sold his membrane lung patent to the U.S. government for just $1, saying, “It’s time to give back for all I’ve received”.

Gattinoni and Kolobow made a formidable partnership. When the disappointing results of the NIH ECMO study emerged, they identified the problem: the use of high tidal volumes and respiratory rates during ECMO. Together, they championed a groundbreaking concept—lung protection and rest—arguing that the focus should not solely be on gas exchange or machine performance but on using the right tool in the right way. Their idea that a membrane lung, by removing CO₂ from blood, could provide complete freedom in ventilatory management laid the foundation for modern lung-protective ventilation strategies during extracorporeal respiratory support.

Back in Italy, Gattinoni began applying Low-Frequency Positive Pressure Ventilation with Extracorporeal CO₂ Removal (LFPPV ECCO2R). While the acronym was awkward, the approach achieved remarkable results, capturing the attention of the intensive care community. One admirer was Professor Denis Melrose, a British cardiac surgeon visiting from London, who brought Gattinoni’s handwritten manuscript back to the UK and facilitated its publication in The Lancet in 1980.

Today, the principles of lung protection and the prevention of Ventilator-Induced Lung Injury (VILI) are standard practice, thanks in no small part to the visionary ideas of Gattinoni and Kolobow.

In the early years of intensive care, a vibrant European community of young clinicians and researchers helped shape the discipline’s foundations. Among them there was a group particularly interested in respiratory pathophysiology, represented among others by Antonio Artigas Raventos, Hilmar Burchardi, Konrad Falke, Göran Hedenstierna, Maurice Lamy, François Lemaire, Peter Suter, Keith Sykes and Adrian Versprille. These pioneers exchanged ideas, data, and findings even before formal publication.

One pivotal moment came when Göran Hedenstierna shared with the group CT scan findings of lung collapse in anesthetized subjects. Gattinoni was immediately intrigued and began applying CT imaging to study Acute Respiratory Distress Syndrome (ARDS). This research revolutionized the understanding of ARDS, shifting its perception from a homogeneous condition to a regionally heterogeneous disease. This led to the groundbreaking “baby lung” concept: the realization that the functional portion of an ARDS-affected lung may be as small as a baby’s lung, necessitating gentle treatment. This research also provided the scientific basis for prone positioning in ARDS management.

Gattinoni’s scientific curiosity extended beyond ARDS, encompassing hemodynamics, sepsis, acid–base balance, and more. He rejected the “principle of authority” (ipse dixit) and consistently sought alternative explanations to improve patient care.

After retiring from the University of Milan at age 70, Gattinoni continued his research at the University of Göttingen, with the support of his close friend Professor Michael Quintel. There, free from administrative and clinical duties, he built another thriving research team, including his wife Federica. His creativity flourished, producing a wealth of new scientific insights.

Though uninterested in sports or physical exercise, intellectual challenges kept his mind constantly engaged. He authored over 600 indexed papers and numerous book chapters and served as president of the European Society of Intensive Care Medicine, the Italian Society of Anesthesia and Intensive Care, and the World Federation of Societies of Intensive and Critical Care Medicine, among other roles and honors.

Beyond his scientific achievements, Gattinoni was really a Renaissance man. He loved art and music, quoted Greek and Latin authors in their original languages, played Mozart on the piano, and sang spirituals. In 1961, he co-founded the Mnogaja Leta vocal quartet, which performed over a thousand concerts and produced 10 LPs, 5 CDs, and 5 videos.

As a leader, Gattinoni inspired loyalty and collaboration. He conducted clinical trials involving thousands of patients and dozens of Italian ICUs, most often relying solely on the shared pride of contributing to meaningful research rather than financial incentives. His generosity, quick wit, and informal teaching style made him an extraordinary “professor”. He famously told students, “If you can explain it to your mom, then you’ve truly understood it”.

Gattinoni often described himself as “lucky”, but he believed that “luck and merit are two links in the same chain”. His work transformed the lives of many, leading them on journeys of discovery, sometimes faltering but more often toward success.

Luciano Gattinoni was a giant in Intensive care Medicine, a brilliant thinker, and a beloved companion in work and life. He was, above all, a true leader.

Authors and Affiliations

1. University of Milan, Milan, Italy

   Antonio Pesenti & Gaetano Iapichino

2. Erasme University Hospital, Free University of Brussels, Ixelles, Belgium

   Jean Louis Vincent

Authors

1. Antonio PesentiView author publications

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2. Gaetano IapichinoView author publications

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Corresponding author

Correspondence to Antonio Pesenti.

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Pesenti, A., Iapichino, G. & Vincent, J.L. Luciano Gattinoni: a tribute to a pioneer in intensive care medicine. Crit Care 28, 423 (2024). https://doi.org/10.1186/s13054-024-05210-9

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• Published: 18 December 2024

• DOI: https://doi.org/10.1186/s13054-024-05210-9

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