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Object: It is increasingly popular to collect as much data as possible in thehospital setting from clinical monitors for research purposes. However, in thissetup the data calibration issue is often not discussed and, rather, implicitlyassumed, while the clinical monitors might not be designed for the dataanalysis purpose. We hypothesize that this calibration issue for a secondaryanalysis may become an important source of artifacts in patient monitor data.We test an off-the-shelf integrated photoplethysmography (PPG) andelectrocardiogram (ECG) monitoring device for its ability to yield a reliablepulse transit time (PTT) signal. Approach: This is a retrospective clinicalstudy using two databases: one containing 35 subjects who underwentlaparoscopic cholecystectomy, another containing 22 subjects who underwentspontaneous breathing test in the intensive care unit. All data sets includerecordings of PPG and ECG using a commonly deployed patient monitor. Wecalculated the PTT signal offline. Main Results: We report a novel constantoscillatory pattern in the PTT signal and identify this pattern as a sawtoothartifact. We apply an approach based on the de-shape method to visualize,quantify and validate this sawtooth artifact. Significance: The PPG and ECGsignals not designed for the PTT evaluation may contain unwanted artifacts. ThePTT signal should be calibrated before analysis to avoid erroneousinterpretation of its physiological meaning.

Unexpected sawtooth artifact in beat-to-beat pulse transit time measured from patient monitor data