Objective: The purpose of this review is to draw up a statement on current knowledge available on the more recent hydroxyethyl starch (HES)., Data Sources: References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files., Study Selection: All categories of articles on this topic have been selected., Data Extraction: Articles have been analysed for biophysics, pharmacology, toxicity, side effects, clinical effects and using prospect of HES., Data Synthesis: The first HES was made available in the United States in 1970. The development of a new generation of HES restarted the discussion on clinical interest and the limits in the use of these macromolecules. This interest is also strengthened today by the recent data attached to plasma substitution in intensive care or perioperative resuscitation. The interest for crystalloids and colloids is still widely debated, and among the latter, the relative interest of the HES last generation compared to older ones. Recent HES development is in line with a decrease molecular weight, change rate molar substitution and to amend the glucose to hydroxyethyl report. The ultimate goal is to reduce the side effects of these molecules preventing their use. Side effects are dominated by haemostasis and renal dysfunction. The latest developments are the so-called HES "balanced" solutions., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)