Ventilation Fundamentals
The 2025 American Heart Association (AHA) Guidelines recommend delivering each breath over one second during manual ventilation. Audiovisual feedback devices have also been shown to improve return of spontaneous circulation (ROSC) and survival to hospital discharge after cardiac arrest.
Delivering a breath over one second highlights an important concept: effective ventilation depends not only on the volume delivered, but also on how that volume is delivered. Controlled flow and proper inspiratory timing are essential to safe ventilation.
This relationship can be described as:
ΔTime = ΔVolume / Flow
Sotair operates as a forcing function, physically guiding provider performance in real time. Through integrated auditory, visual, and haptic cues, Sotair helps ensure each breath is delivered safely and consistently—approaching the performance of a mechanical ventilator during manual ventilation.
SotairIQ extends this concept as a manual ventilation training platform. By gamifying ventilation and visualizing key parameters—including flow, inspiratory time, pressure, rate, and volume—SotairIQ helps providers build muscle memory and reduce the risks of over-pressurization, hyperventilation, and underventilation through consistent real-time feedback.
Preventing Over- and Under-Ventilation
The 2025 AHA Guidelines emphasize that excessive ventilation can cause gastric insufflation, regurgitation, and decreased cardiac output, while insufficient ventilation reduces survival.
The guidelines also reference an in-hospital study showing that:
-
Hypocapnia (too much ventilation)
-
Severe hypercapnia (too little ventilation)
-
Large swings between the two
were associated with higher rates of unfavorable neurological outcomes at one month compared with mild hypercapnia.
Training with SotairIQ and clinical use of Sotair alongside capnography devices can help providers deliver safer and more consistent ventilation, supporting improved neurologically intact survival for patients.
By limiting inspiratory flow and enforcing proper timing, Sotair acts as a mechanical guardrail, maintaining safer airway pressures while encouraging adequate tidal volumes. SotairIQ reinforces these principles through gamified training and real-time feedback, helping providers develop durable ventilation skills.
Bag Size and Patient Needs
The 2025 AHA Guidelines cite studies showing that pediatric and small adult (1,000 mL) bags often fail to provide adequate tidal volumes for adult patients.
Data collected using SotairIQ confirm this limitation, particularly during mask ventilation, where leak and poor mask seal can further reduce delivered tidal volume.
In many situations, larger bags may be required to meet adult ventilatory demands—especially when providers encounter poor mask seals or increased airway resistance.
SotairIQ training helps providers master manual ventilation technique, allowing them to adapt their bagging strategy to the patient’s physiology and clinical situation.
Rapid Intervention for Apnea
The 2025 AHA Guidelines note that within 90 seconds of apnea, oxygen levels can fall dangerously low, placing the brain and heart at risk of injury.
When Sotair is pre-attached to a BVM, providers can initiate immediate and controlled ventilation, helping ensure the first breaths delivered are both effective and protective.
Station-based training with SotairIQ helps build confidence, speed, and muscle memory, improving the precision of both initial and ongoing ventilations during airway emergencies.
Training and Skill Retention
The 2025 AHA Guidelines recommend feedback learning, spaced learning, and gamified training as effective strategies for improving skill retention.
SotairIQ integrates all three methods into a portable training platform, allowing organizations to deliver continuous, low-cost, data-driven training without requiring complex simulation manikins.
This approach helps providers maintain proficiency in a skill that is critical yet highly variable in real-world resuscitation.
Cognitive Aids and Human Factors
The 2025 AHA Guidelines recognize that cognitive overload is common during high-stress resuscitation events.
Sotair functions as both a forcing function and embedded cognitive aid, guiding flow and inspiratory timing through tactile feedback. This allows providers to maintain focus on the patient while still delivering consistent, guideline-aligned ventilation, improving both safety and performance.
Airway Management
The 2025 AHA Guidelines state that cricoid pressure is ineffective and is not recommended during airway management.
Sotair helps reduce the risk of gastric insufflation without obstructing airflow, offering an evidence-aligned alternative for safer airway management during manual ventilation.
Learn More
Sotair:
SotairIQ:
Next Flow Control Manual Ventilation Workshop
Learn more about upcoming training opportunities:
Mastering Flow Control in Manual Ventilation – Reducing Variability & Improving Outcomes