Design and Architecture of Airmod: An Active Noise Cancellation and Deep Learning System for Real-Time Respiratory Rate Estimation from Tracheal Sounds

Tracheal auscultation is recommended by clinical practice guidelines, and required by some U.S. state regulations, for monitoring ventilation during procedural sedation and monitored anesthesia care. However, continuous auscultation with a conventional stethoscope is impractical, susceptible to ambient noise, and difficult to interpret. We developed the Artificial Intelligence Respiratory MOnitoring Device (Airmod), an FDA-cleared software as a medical device (510(k) K242798) that continuously monitors tracheal sounds and estimates breath-to-breath respiratory rate in real time. In this paper, we describe its software architecture and key processing modules. Ambient noise is suppressed by active noise control, using a normalized least-mean-square adaptive filter with a dual-microphone electronic stethoscope. A multiclass convolutional bidirectional gated recurrent unit (CNN-BiGRU) model detects inhalations and exhalations in 15-s inference windows. It was trained on HF_Tracheal_V2, a new database of 373 continuous tracheal sound recordings (8,521 min; 107,644 labeled inhalations) from 369 subjects under sedation. To handle continuous acoustic streaming, Airmod runs inference on overlapping 15-s windows. It refines the detected inhalations by removing incomplete events, low-energy false positives, and double counts, concatenates them into a history list, and estimates respiratory rate from the mean period of the last three breaths. On the test set, at the default 2-s prediction interval with refinement enabled, inhalation detection achieved a sensitivity of 0.828, a positive predictive value of 0.832, and an F1-score of 0.830. Airmod also broadcasts the noise-cancelled tracheal sound and displays a real-time spectrogram to help clinicians recognize respiratory abnormalities.