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.

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