About

Ann D. Cuccia, MPH, RT, RRT-NPS, RPFT, AE-C, FAARC, is the Director of Clinical Education for the Respiratory Care and Polysomnographic Specialty Option Programs at the School of Health Professions, Stony Brook University. She holds a Master of Public Health with a concentration in Health Analytics from Stony Brook University, along with Bachelor of Science degrees in CardioRespiratory Science from Stony Brook University and in Biology from Longwood University. Dr. Cuccia serves as a Clinical Professor at the university, contributing to the education and training of students in respiratory care and related fields. Her professional credentials include registered respiratory therapist, advanced practice respiratory therapist, polysomnography technician, asthma educator, and fellow of the American Association for Respiratory Care. She is based at the Stony Brook University Health Science Center, where she oversees clinical education and program development in respiratory care and polysomnography.

Research topics

• Medicine
• Anesthesia
• Biomedical engineering
• Intensive care medicine
• Nuclear medicine

Selected publications

• Jet Nebulization During Mechanical Ventilation: Mass Balance Analysis

  Respiratory Care · 2025-10-03 · 1 citations

  articleOpen access

  BACKGROUND: ), and circuit compliance. METHODS: ) was nebulized. A well counter measured filters inhaled and expiratory mass (IM, EM), and nebulizer residual (NR). Tubing deposition was measured with a gamma camera. A shielded ratemeter measured output rate and treatment time. RESULTS: (0.55 s) reduced IM and further increased treatment time. CONCLUSIONS: Optimal conditions for jet nebulization were IP position, HME circuit, continuous nebulization, and stiff tubing. Humidification should be supplied with an aerosol HME. If active humidification, IP breath-actuated was most efficient but with marked increase in treatment time.

  PublisherDOI

• External Jet Nebulization and Measured Ventilator Performance

  Respiratory Care · 2024-05-14 · 3 citations

  articleOpen accessSenior author

  BACKGROUND: During invasive ventilation, external flow jet nebulization results in increases in displayed exhaled tidal volumes (V T ). We hypothesized that the magnitude of the increase is inaccurate. An ASL 5000 simulator measured ventilatory parameters over a wide range of adult settings: actual V T , peak inspiratory pressure (PIP), and time to minimum pressure. METHODS: Ventilators with internal and external flow sensors were tested by using a variety of volume and pressure control modes (the target V T was 420 mL). Patient conditions (normal, COPD, ARDS) defined on the ASL 5000 were assessed at baseline and with 3.5 or 8 L/min of added external flow. Patient-triggering was assessed by reducing muscle effort to the level that resulted in backup ventilation and by changing ventilator sensitivity to the point of auto-triggering. RESULTS: Results are reported as percentage change from baseline after addition of 3.5 or 8 L/min external flow. For ventilators with internal flow sensors, changes in displayed exhaled V T ranged from 10% to 118%, however, when using volume control, actual increases in actual V T and PIP were only 4%–21% ( P = .063, .031) and 6%–24% ( P = .25, .031), respectively. Changes in actual V T correlated closely with changes in PIP ( P < .001; R 2 = 0.68). For pressure control, actual V T decreased by 3%–5% ( P = .031) and 4%–9% ( P = .031) with 3.5 and 8 L/min respectively, PIP was unchanged. With external flow sensors at the distal Y-piece junction, volume and pressure changes were statistically insignificant. The time to minimum pressure increased at most by 8% ( P = .02) across all modes and ventilators. The effects on muscle pressure were minimal (∼1 cm H 2 O), and ventilator sensitivity effects were nearly undetectable. CONCLUSIONS: External flow jet nebulization resulted in much smaller changes in volume than indicated by the ventilator display. Statistically significant effects were confined primarily to machines with internal flow sensors. Differences approached the manufacturer-reported variation in ventilator baseline performance. During nebulizer therapy, effects on V T can be estimated at the bedside by monitoring PIP.

  PublisherOA PDFDOI

• Multidrug Aerosol Delivery During Mechanical Ventilation

  Journal of Aerosol Medicine and Pulmonary Drug Delivery · 2023-05-31 · 2 citations

  articleOpen access1st authorCorresponding

  Background: In the critically ill, pulmonary vasodilators are often provided off label to intubated patients using continuous nebulization. If additional aerosol therapies such as bronchodilators or antibiotics are needed, vasodilator therapy may be interrupted. This study assesses aerosol systems designed for simultaneous delivery of two aerosols using continuous nebulization and bolus injection without interruption or circuit disconnection. Methods: One i -AIRE dual-port breath-enhanced jet nebulizer (BEJN) or two Aerogen ® Solo vibrating mesh nebulizers (VMNs) were installed on the dry side of the humidifier. VMN were stacked; one for infusion and the second for bolus drug delivery. The BEJN was powered by air at 3.5 L/min, 50 psig. Radiolabeled saline was infused at 5 and 10 mL/h with radiolabeled 3 and 6 mL bolus injections at 30 and 120 minutes, respectively. Two adult breathing patterns (duty cycle 0.13 and 0.34) were tested with an infusion time of 4 hours. Inhaled mass (IM) expressed as % of initial syringe activity (IM%/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were measured by calibrated ratemeter. Results: IM%/h during continuous infusion was linear and predictable, mean ± standard deviation (SD): 2.12 ± 1.45%/h, 2.47 ± 0.863%/h for BEJN and VMN, respectively. BEJN functioned without incident. VMN continuous aerosol delivery stopped spontaneously in 3 of 8 runs (38%); bolus delivery stopped spontaneously in 3 of 16 runs (19%). Tapping restarted VMN function during continuous and bolus delivery runs. Bolus delivery IM% (mean ± SD): 20.90% ± 7.01%, 30.40% ± 11.10% for BEJN and VMN, respectively. Conclusion: Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization.

  PublisherDOI

• 1363: EXTERNAL JET NEBULIZATION AND MEASURED VENTILATOR PERFORMANCE

  Critical Care Medicine · 2023-12-14

  articleSenior author

  Introduction: During invasive ventilation, external flow jet nebulization results in increases in displayed exhaled volumes (VTe). We hypothesized that the magnitude of the increase is inaccurate. An ASL-5000 simulator measured multiple ventilatory parameters over a wide range of adult settings; actual tidal volume (VTasl), peak inspiratory pressure (PIP), and time to minimum pressure, (TPmin). Methods: Ventilators with internal and external flow sensors were tested using a variety of volume and pressure control modes (target tidal volume was 420mL). Patient conditions (normal, COPD, ARDS) defined on the ASL were assessed at baseline and with 3.5 or 8L/min of added external flow. Patient triggering was tested by reducing muscle effort to the level resulting in backup ventilation and by changing ventilator sensitivity to the point of auto triggering. Results: Results are reported as % change from baseline. For ventilators with internal flow sensors, across all modes changes in VTe ranged from 41 to 118%. For volume-control, addition of 3.5 or 8L/min external flow resulted in actual increases in VTasl and PIP of 4.4-12% (P=.031) and 12-24% (P=.031) respectively. Changes in VTasl correlated closely with changes in PIP (P<.0001, R2=.682). For pressure-control, VTasl decreased by 3.2-4.6% (P=.031) and 3.6-9.0% (P=.031), with 3.5 and 8L/min, PIP was unchanged. With flow sensors at the distal Y junction, volume and pressure changes were statistically insignificant. TPmin was found to increase at most by 8.2% (P=.015) across all modes and ventilators. Muscle pressure effects were minimal (~1cm H2O) and ventilator sensitivity effects were nearly undetectable. Conclusions: External flow jet nebulization results in smaller changes in volume than indicated by the ventilator display. Statistically significant effects were confined primarily to machines with internal flow sensors. Differences approached the manufacturer reported variation in ventilator baseline performance. Therapists can assess shifts in VT qualitatively by monitoring PIP during nebulizer therapy.

  PublisherDOI

• Real-Time Analysis of Dry-Side Nebulization With Heated Wire Humidification During Mechanical Ventilation

  Respiratory Care · 2022-05-31 · 20 citations

  article

  BACKGROUND: Recent observational studies of nebulizers placed on the wet side of the humidifier suggest that, after some time, considerable condensation can form, which triggers an occlusion alarm. In the current study, an inline breath-enhanced jet nebulizer was tested and compared in vitro with a vibrating mesh nebulizer on the humidifier dry–inlet side of the ventilator circuit. METHODS: Two duty cycle breathing patterns were tested during continuous infusion (5 or 10 mL/h) with and without dynamic changes in infusion flow and duty cycle, or bolus delivery (3 or 6 mL) of radiolabeled saline solution. Inhaled mass (IM) was measured by a real-time ratemeter (µCi/min) and analyzed by multiple linear regression. RESULTS: During simple continuous infusion, IM increased linearly for both nebulizer types. IM variability was attributable to the duty cycle ( P &lt; .001) (34%) and infusion flow ( P &lt; .001) (32%) but independent of nebulizer technology ( P = .38) (7%). Dynamic continuous infusion studies that simulate clinical scenarios with ventilator and pump flow changes demonstrated a linear increase in the rate of aerosol that was dependent on pump flow ( P &lt; .001) (63%) and minimally dependent on the duty cycle ( P = .003) (8%). During bolus treatments, IM increased linearly to plateau. IM variability was attributable to the duty cycle ( P &lt; .001) (40%) and residual radioactivity in the nebulizer ( P &lt; .001) (20%). Separate analysis revealed that the vibrating mesh nebulizer residual volume contributed 16% of the variability and inline breath-enhanced jet nebulizer contributed 5%. IM variability was independent of bolus volume ( P = .82) (1%). System losses were similar (the inline breath-enhanced jet nebulizer: 32% residual in nebulizer; the vibrating mesh nebulizer: 34% in circuitry). CONCLUSIONS: Aerosol delivery during continuous infusion and bolus delivery was comparable between the inline breath-enhanced jet nebulizer and the vibrating mesh nebulizer, and was determined by pump flow and initial ventilator settings. Further adjustments in ventilator settings did not significantly affect drug delivery. Expiratory losses predicted by the duty cycle were reduced with placement of the nebulizer near the ventilator outlet.

  PublisherDOI

• COMBINED BOLUS AND CONTINUOUS NEBULIZATION DURING MECHANICAL VENTILATION: DUAL THERAPY FOR RESPIRATORY FAILURE

  CHEST Journal · 2022-06-01

  articleOpen access
  PublisherOA PDFDOI

• Aerosol Delivery via Nebulization From the Dry Side of a Heated Humidifier During Mechanical Ventilation

  Respiratory Care · 2021-10-01

  article

  Background:Previous work measured aerosol delivery for i-AIRE, a prototype inline breath-enhanced jet nebulizer (BEJN) located on the wet/outlet of the humidifier. Recent observations reported that placement of single-patient-use nebulizers in this location results in excess condensation in the inspiratory limb and nebulizer flooding. The present study tested i-AIRE in vitro compared to Solo, a vibrating mesh nebulizer (VMN) on the humidifier dry/inlet side of the ventilator circuit during continuous and bolus treatment nebulization. Methods:Two adult duty cycle (DC) breathing patterns were tested during continuous infusion (5 or 10 mL/h) with and without dynamic changes in infusion rate and DC, or bolus delivery (3 or 6 mL) of radiolabeled saline. Inhaled mass (IM) reported as a function of time was measured in real-time using a gamma ratemeter (µCi/min) and analyzed by multiple linear regression. Expiratory losses (EXP) were measured and reported as the IM:EXP ratio. Results:During simple continuous infusion, IM increased linearly for both nebulizer types. IM variability was attributable to DC (P < 0.001, 34%) and infusion flow (P < 0.001, 32%), but independent of nebulizer technology (P = 0.381, 7%). Dynamic continuous infusion studies mimicking clinical scenarios with ventilator and pump flow changes demonstrated a linear increase in the rate of aerosol that was dependent on pump flow (P < 0.01, 63%) and was minimally dependent on duty cycle (P = 0.03, 8%). During bolus treatments, IM increased linearly to plateau. IM variability was attributable to DC (P < 0.001, 40%) and residual nebulizer volume (P < 0.001, 20%). Separate analysis revealed VMN residual volume contributing 16% of the variability and BEJN 5%. IM variability was independent of bolus volume (P = 0.82, 1%). System losses were similar (BEJN: 32% residual in nebulizer; VMN: 34% in circuitry). IM:EXP ratio was approximately 10 times greater than predicted by the ventilator DC for both nebulizer types during bolus and continuous infusion. Conclusions:Aerosol delivery during continuous infusion and bolus delivery is comparable between the BEJN and VMN and determined by pump flow and initial ventilator settings. Once treatment is initiated, further adjustments in ventilator settings did not significantly affect drug delivery. Furthermore, placement of the nebulizer on the humidifier dry-side allows for a greater inhaled mass-to-expiratory loss ratio than predicted by ventilator DC.

  PublisherDOI

• Real-Time <i>In Vitro</i> Assessment of Aerosol Delivery During Mechanical Ventilation

  Journal of Aerosol Medicine and Pulmonary Drug Delivery · 2021-07-06 · 8 citations

  articleOpen access

  Background: A new real-time method for assessing factors determining aerosol delivery is described. Methods: A breath-enhanced jet nebulizer operated in a ventilator/heated humidifier system was tested during bolus and continuous infusion aerosol delivery. 99m Tc (technetium)/saline was either injected (3 or 6 mL) or infused over time into the nebulizer. A shielded gamma ratemeter was oriented to count radioaerosol accumulating on an inhaled mass (IM) filter at the airway opening of a test lung. Radioactivity measured at 2–10-minute intervals was expressed as % nebulizer charge (bolus) or % syringe activity per minute infused. All circuit parts were measured and imaged by gamma camera to determine mass balance. Results: Ratemeter activity quantitatively reflected immediate changes in IM: 3 and 6 mL bolus IM% = 16.1 and 18.8% in 6 and 14 minutes, respectively; infusion IM% = 0.64 + 0.13 (run time, min), R 2 0.999. Effect of nebulizer priming and system anomalies were readily detected in real time. Mass balance (basis = dose infused in 90 minutes): IM 39.2%, breath-enhanced jet nebulizer residual 35.5%, circuit parts including humidifier 23.4%, and total recovery 98.1%. Visual analysis of circuit component images identified sites of increased deposition. Conclusion: Real-time ratemeter measurement with gamma camera imaging provides operational feedback during in vitro testing procedures and yields a detailed analysis of the parameters influencing drug delivery during mechanical ventilation. This method of analysis facilitates assessment of device function and influence of circuit parameters on drug delivery.

  PublisherDOI

• Multidrug Aerosol Delivery During Mechanical Ventilation

  Respiratory Care · 2021-10-01

  article1st authorCorresponding

  Background:Continuous nebulization of pulmonary vasodilators is an off-label therapy for hypoxemia. Patients may require additional aerosol therapies such as bronchodilators and antibiotics. This study evaluates delivery of concurrent therapy of multiple medications during continuous nebulization without interruption or circuit disconnection. Methods:One i-AIRE dual-port breath-enhanced jet nebulizer (BEJN) or two Aerogen Solo vibrating mesh nebulizers (VMN) were installed on the dry side of the humidifier. VMN were stacked; one for infusion, the second for bolus drug delivery. The BEJN was powered by air at 3.5 L/min, 50 psig. Radiolabeled saline was infused at 5 & 10 mL/h with radiolabeled 3 mL and 6 mL bolus injections at 30 and 120 min respectively. Two adult breathing patterns (duty cycle 0.13 and 0.34) were tested with an infusion time of 4 h. Inhaled Mass expressed as % of initial syringe activity (IM %/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were documented. Results:IM %/h during continuous infusion was linear and predictable, mean ± SD: 3.63 ± 2.02%, 3.54 ± 2.78% for BEJN and VMN, respectively. BEJN functioned without incident. VMN continuous aerosol delivery stopped spontaneously in 4 of 8 runs (50%); bolus delivery stopped spontaneously in 9 of 16 runs (56%). Tapping restarted VMN function during 3 of 4 continuous runs and 7 of 9 bolus delivery runs. Bolus delivery IM% (mean ± SD): 22.17 ± 7.65%, 14.37 ± 10.62% for BEJN and VMN, respectively. Conclusions:Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization.

  PublisherDOI

• Active Humidification and Delivery of Aerosols

  Respiratory Care · 2020-10-01

  article

  Background:Aerosol drug delivery by devices positioned on the “wet” side of the humidifier is significantly affected by humidification, with reported aerosol losses of 50 to 75% for nebulizers and 40% for MDIs. The unpredictable losses in these circuits led some investigators to advocate avoidance of active humidification during aerosol therapy. However, humidification is required for prolonged delivery of controlled doses of drugs (eg, vasodilators). Recently, we tested wet-side nebulization using a prototype breath-enhanced nebulizer and achieved good control of drug delivery. However, short term aerosol studies do not assess the stability of ventilator circuit humidification over time when devices are left in the circuit. To test this stability, we studied the humidified ventilator circuit over 24-48 hours using wet-side nebulizer placement on the humidifier. Methods:A standard F&P humidifier/heated wire circuit was operated continuously during mechanical ventilation of test lungs over several days with a prototype i-AIRE breath-enhanced nebulizer or Aerogen Solo positioned at the humidifier outlet. The humidifier outlet thermistor was located either at the inlet cuff of the inspiratory limb or the humidifier outlet. Room temperature was controlled at 22 C. Periodically, the devices and inspiratory limb tubing were assessed for water accumulation, and the ventilator for alarm conditions. Results:Within 24-48 h, enough condensation formed within all devices and/or the inspiratory limb to trigger an occlusion alarm on the ventilator. By applying insulating materials, condensation was shown to be a function of heat loss caused by interposing devices between the humidifier outlet and the inspiratory limb (where the heated wire begins). This phenomenon could not be avoided by moving the thermistor to different locations. Conclusions:Positioning nebulizing devices on the wet side of the humidifier with a heated wire circuit is not feasible. Nebulizing systems left in the circuit should be located on the dry side of the humidifier.

  PublisherDOI

Frequent coauthors

• Gerald C. Smaldone

  Stony Brook University Hospital

  33 shared

• Michael McPeck

  Stony Brook University Hospital

  21 shared

• Sunya Ashraf

  Stony Brook University Hospital

  6 shared

• Lucy B. Palmer

  Florey Institute of Neuroscience and Mental Health

  5 shared

• Janice A. Lee

  Stony Brook University Hospital

  5 shared

• Sanford R. Simon

  Stony Brook University

  4 shared

• Thomas G. O’Riordan

  4 shared

• Ashwin A Gowda

  State University of New York

  4 shared

Education

• B.S. Biology

  Longwood University

• B.S. Cardiorespiratory Science

  Stony Brook University

• M.P.H.

  Stony Brook University

Awards & honors

• FAARC