Bio

Clinical Focus


  • Pediatric Critical Care Medicine

Academic Appointments


Professional Education


  • Medical Education: Western University of Health Sciences College of Osteopathic Medicine of the Pacific (2000) CA
  • Board Certification: American Board of Pediatrics, Pediatric Critical Care Medicine (2010)
  • Fellowship: AI Dupont Hospital for Children (2010) DE
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2005)
  • Fellowship: Cedars-Sinai Nephrology Fellowship Program (2005) CA
  • Board Certification: American Board of Pediatrics, Pediatrics (2004)
  • Residency: LACplusUSC Pediatric Residency (2004) CA

Teaching

Publications

All Publications


  • Efficacy of Intravenous Ketamine in Adolescent Treatment-Resistant Depression: A Randomized Midazolam-Controlled Trial. The American journal of psychiatry Dwyer, J. B., Landeros-Weisenberger, A., Johnson, J. A., Londono Tobon, A., Flores, J. M., Nasir, M., Couloures, K., Sanacora, G., Bloch, M. H. 2021: appiajp202020010018

    Abstract

    OBJECTIVE: Adolescent depression is prevalent and is associated with significant morbidity and mortality. Although intravenous ketamine has shown efficacy in adult treatment-resistant depression, its efficacy in pediatric populations is unknown. The authors conducted an active-placebo-controlled study of ketamine's safety and efficacy in adolescents.METHODS: In this proof-of-concept randomized, double-blind, single-dose crossover clinical trial, 17 adolescents (ages 13-17) with a diagnosis of major depressive disorder received a single intravenous infusion of either ketamine (0.5 mg/kg over 40 minutes) or midazolam (0.045 mg/kg over 40 minutes), and the alternate compound 2 weeks later. All participants had previously tried at least one antidepressant medication and met the severity criterion of a score >40 on the Children's Depression Rating Scale-Revised. The primary outcome measure was score on the Montgomery-Asberg Depression Rating Scale (MADRS) 24 hours after treatment.RESULTS: A single ketamine infusion significantly reduced depressive symptoms 24 hours after infusion compared with midazolam (MADRS score: midazolam, mean=24.13, SD=12.08, 95% CI=18.21, 30.04; ketamine, mean=15.44, SD=10.07, 95% CI=10.51, 20.37; mean difference=-8.69, SD=15.08, 95% CI=-16.72, -0.65, df=15; effect size=0.78). In secondary analyses, the treatment gains associated with ketamine appeared to remain 14 days after treatment, the latest time point assessed, as measured by the MADRS (but not as measured by the Children's Depression Rating Scale-Revised). A significantly greater proportion of participants experienced a response to ketamine during the first 3 days following infusion as compared with midazolam (76% and 35%, respectively). Ketamine was associated with transient, self-limited dissociative symptoms that affected participant blinding, but there were no serious adverse events.CONCLUSIONS: In this first randomized placebo-controlled clinical trial of intravenous ketamine in adolescents with depression, the findings suggest that it is well tolerated acutely and has significant short-term (2-week) efficacy in reducing depressive symptoms compared with an active placebo.

    View details for DOI 10.1176/appi.ajp.2020.20010018

    View details for PubMedID 33653121

  • How Residents Learn During Emergent Situations May Be Different Than How We Were Taught. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Couloures, K. G. 2020; 21 (10): 901–2

    View details for DOI 10.1097/PCC.0000000000002466

    View details for PubMedID 33009300

  • Can We Use Tissue Inhibitor Metalloproteinase-2 and Insulin-Like Growth Factor Binding Protein-7 Levels to Predict Acute Kidney Injury in Neonate and Infants Undergoing Cardiac Surgery? Not Yet. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Couloures, K. G., Marsenic, O. 2020; 21 (6): 593–94

    View details for DOI 10.1097/PCC.0000000000002282

    View details for PubMedID 32483026

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