A Key Clinical Message:
  1. It is rightly said that prevention is better than cure. Given the extreme difficulty in management of conjoined twin along with risk to two lives, it’s even truer. The general public should be made aware for such group of patients and to make them follow covid appropriate behavior. Vaccination to be given on priority basis to these subsets.
  2. A more robust approach of telemedicine consultation is required for management of patients in remote areas at the time of pandemic.
  3. Intubation was also a challenge in our case. There must be difficult airway cart at hand before intubation. Ultrasound guided central line placement should be the norm. Prone positioning is difficult in such patients. An alternative to this should be turning both the patients in toto around. But practically this is difficult and requires a lot of manpower. Ventilator management of these patients is still intriguing. We failed to maintain oxygen saturation with volume control mode and a high airway pressure. We changed the mode to pressure control mode targeting improved oxygen saturation. However, it was still very challenging to ventilate.