Background The adverse effects of hydroxyethyl starch on renal function, coagulation and outcome of critically ill patients are a great concern of clinicians. Objective To review the recent progress of the use of hydroxyethyl starch in critically ill patients. Content Based on literatures published in recent years, we discussed the effects of hydroxyethyl starch on renal function, coagulation and mortality in patients, including pediatric patients, with sepsis, acute severe pancreatitis, trauma, traumatic brain injury and burns, in patients undergoing cardiac surgery and organ transplantation. Trend Use of hydroxyethyl starch has harmful effects on prognosis in patient with sepsis and blunt trauma, as well as in patients undergoing cardiac surgery under cardiopulmonary bypass and organ transplantation. Use of hydroxyethyl starch may improve the prognosis in patients with acute severe pancreatitis, in patients with traumatic brain injury and burns, as well as in pediatric patients, the safety of hydroxyethyl starch is worth of further demonstration.